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Azathioprine (AZA) plus short-term exclusive enteral nutrition (EEN) lowered endoscopic recurrence (ER) rates in high-risk Crohn’s disease (CD) patients at one year, with a transient dip in quality of life, suggesting the need for more extensive, long-term studies.
The following is a summary of “Azathioprine plus exclusive enteral nutrition versus azathioprine monotherapy for the prevention of postoperative recurrence in patients with Crohn’s disease: an open-label, single-centre, randomised controlled trial,” published in the January 2024 issue of Gastroenterology by Duan et al.
While Azathioprine (AZA) effectively prevents endoscopic recurrence (ER) in Crohn’s disease (CD) after 3 months, EEN offers a swift remission-maintaining option for CD patients facing endoscopic recurrence (ER) risk.
They enrolled 84 high-risk CD patients who underwent intestinal resection, assigning them to receive either AZA alone or AZA plus a 3-month exclusive enteral nutrition (AZA+EEN) postoperatively. The primary outcome measured was the rate of ER at month 12, with secondary endpoints including ER rate at month 3, clinical recurrence (CR), Crohn’s Disease Activity Index (CDAI) scores, fecal calprotectin (FC), and C-reactive protein (CRP) levels. Quality of life assessments utilized the Short Form-36 (SF-36) and the Inflammatory Bowel Disease Questionnaire (IBDQ).
The results showed at both 12 months (AZA+EEN: 33.3% [13/39] vs. AZA: 63.2% [24/38], P=0.009) and 3 months post-surgery (AZA+EEN: 8.6% [3/35] vs. AZA: 28.1% [9/32], P=0.037), the AZA+EEN group had notably lower rates of ER compared to the AZA group. Similar rates of CR were observed between the two groups at month 3 and month 12. Analysis showed no significant differences in CDAI scores, FC, albumin level, and CRP between the two groups. AZA group had the superior quality of life at month 3, leveling with the AZA+EEN group from months 5 to 12 postoperatively.
Investigators concluded that AZA plus short-term EEN lowered ER rates in high-risk CD patients at one year, with a transient dip in quality of life, suggesting the need for more extensive, long-term studies.