Role of thiopurines as disease-modifying agents in Crohns disease

We agree with Danese et al1 that prospective studies to evaluate the disease-modifying action of antitumour necrosis factor (anti-TNF) drugs are overdue. As a counterpoint to this informative review, we would like to highlight some additional evidence for the role of thiopurines as disease-modifying agents in Crohn's disease. A cohort study by Magro et al2 supports a role for thiopurines in delaying phenotype progression from an inflammatory (B1) to a stricturing/penetrating (B2/B3) disease (HR 0.15, 95% CI 0.11 to 0.19). A meta-analysis of 10 population-based, multicentre, and referral centre studies comprising 12 586 patients found thiopurine use was associated with a 40% reduction in risk of first intestinal surgery (HR 0.59, 95 % CI 0.48 to 0.73).3 Furthermore several studies also support a role for early thiopurine use particularly in young patients who are at greater risk of disease progression.4–6 RAPID...

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