mercaptopurine and Rectal-Diseases

Topics: Biopsy, Needle; Colitis, Ulcerative; Constriction, Pathologic; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Follow-Up Studies; Humans; Immunohistochemistry; Infliximab; Male; Mercaptopurine; Middle Aged; Proctoscopy; Rare Diseases; Rectal Diseases; Risk Assessment; Severity of Illness Index; Sigmoidoscopy

Controlled trials have demonstrated the efficacy of methotrexate in the induction and maintenance of remission in luminal Crohn's disease; however, its effect on fistulizing disease is unknown.. To describe the response to methotrexate therapy in a series of patients with fistulizing Crohn's disease.. A retrospective chart review was conducted of all patients with Crohn's disease receiving methotrexate in one practice. The response of patients with fistulizing and luminal disease was assessed using clinical and laboratory criteria. Fistula response was categorized as either complete or partial closure.. Thirty-seven courses of methotrexate therapy were given to 33 patients with luminal and/or fistulizing Crohn's disease. In 16 patients with fistulas, four (25%) had complete closure, five (31%) had partial closure and all had failed or were intolerant to 6-mercaptopurine therapy. Overall, response to methotrexate was seen in 23 of 37 (62%) treatment courses in patients with luminal and/or fistulizing Crohn's disease. Two of the 33 patients (6%) had a significant adverse event.. In this case series, 56% of patients with Crohn's fistulas on methotrexate showed a complete or partial response to therapy. Further studies are needed to confirm the role of methotrexate alone, and in combination with other therapies, for the treatment of fistulizing Crohn's disease.

Topics: Abdominal Wall; Administration, Oral; Adolescent; Adult; Aged; Crohn Disease; Cutaneous Fistula; Cyclosporine; Female; Gastrointestinal Agents; Humans; Injections, Intramuscular; Intestinal Fistula; Male; Mercaptopurine; Middle Aged; Rectal Diseases; Retrospective Studies; Treatment Outcome; Urinary Bladder Diseases; Urinary Fistula; Vaginal Fistula

Although 6-mercaptopurine is often used to treat adolescents with intractable Crohn's disease, its long-term efficacy has not yet been studied in this population. This study shows data derived from 36 adolescents (mean age +/- SD, 16.5 +/- 3.3 years; 27 males, 9 females) treated at least 6 months with 6-mercaptopurine (1.5 mg.kg-1.day-1, maximum of 75 mg/day). Sites of Crohn's disease at the start of 6-mercaptopurine therapy included 17 ileocolic, 9 pancolic, 7 small bowel, and 3 partial colon. All had received corticosteroids, sulfasalazine, antibiotics, and nutritional support for 5.0 +/- 3.0 years before administering 6-mercaptopurine, but intractable symptoms persisted. Disease activity lessened during the first year of 6-mercaptopurine, reflected by a higher Lloyd-Still disease activity score (pre, 64 +/- 9 vs. 6-mercaptopurine, 72 +/- 11; P less than 0.0001). General activity, physical examination, nutrition, and laboratory subscores all improved (P less than 0.004). Lessened disease activity occurred despite concomitant decrease in duration of prednisone use (pre, 9.5 +/- 4.2 vs. 6-mercaptopurine, 6.6 +/- 4.9 months/year; P less than 0.001) and cumulative annual prednisone exposure (pre, 3672 +/- 2106 vs. 6-mercaptopurine, 1964 +/- 1460 mg; P less than 0.0007). The frequency of perianal fistulae and abscesses also decreased (P less than 0.01) during treatment. Annual rates of hospitalization decreased in 44% of subjects during 6-mercaptopurine treatment, while increasing in only 22%. Follow-up beyond 1 year of 6-mercaptopurine treatment showed continued remission in 23 of 30 subjects. No serious complications were seen. 6-mercaptopurine is an effective long-term therapy for adolescents with intractable Crohn's disease. While inducing remission, it also has a significant steroid-sparing effect which may be of particular benefit to this population.

Topics: Abscess; Adolescent; Adult; Anti-Bacterial Agents; Child; Crohn Disease; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Male; Mercaptopurine; Prednisone; Rectal Diseases; Rectal Fistula; Sulfasalazine; Time Factors

Topics: Adolescent; Adult; Azathioprine; Body Temperature; Colitis, Ulcerative; Female; Humans; Male; Mercaptopurine; Middle Aged; Rectal Diseases