Cochrane · systematic review · CD010233
Azathioprine and 6‐mercaptopurine for maintenance of surgically‐induced remission in Crohn's disease
Gjuladin‐Hellon, T, Iheozor‐Ejiofor, Z, Gordon, M, et al. · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
21
current version
GRADE rated
17
No studies
3
Included studies
NR
No studies 3 · 14.3%Ungraded 1 · 4.8%Very low 7 · 33.3%Low 8 · 38.1%Moderate 2 · 9.5%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyAzathioprine or 6‐mercaptopurine compared to placebo for maintenance of surgically‐induced remission in Crohn's disease
Population: People with surgically‐induced remission in Crohn's disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical relapse Azathioprine or 6‐mercaptopurine vs placebo | RR 0.79 [0.67, 0.92] | 3 studies · 408 participants | Moderate Downgraded: imprecision |
Endoscopic relapse Azathioprine or 6‐mercaptopurine vs placebo | RR 0.85 [0.64, 1.13] | 2 studies · 321 participants | Low Downgraded: imprecision, inconsistency |
Radiologic relapse Azathioprine or 6‐mercaptopurine vs placebo | no estimate extracted | NR | No studies |
Surgical relapse Azathioprine or 6‐mercaptopurine vs placebo | no estimate extracted | NR | No studies |
Adverse events Azathioprine or 6‐mercaptopurine vs placebo | RR 1.36 [0.57, 3.27] | 2 studies · 168 participants | Low Downgraded: imprecision, inconsistency |
Serious adverse events Azathioprine or 6‐mercaptopurine vs placebo | RR 1.78 [0.39, 8.18] | 2 studies · 327 participants | Low Downgraded: imprecision, inconsistency |
Withdrawal due to adverse events Azathioprine or 6‐mercaptopurine vs placebo | RR 0.9 [0.63, 1.29] | 3 studies · 408 participants | Moderate Downgraded: imprecision, inconsistency |
Azathioprine or 6‐mercaptopurine compared to 5‐aminosalicylic acid for maintenance of surgically‐induced remission in Crohn's disease
Population: People with surgically‐induced remission in Crohn's disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical relapse Azathioprine or 6‐mercaptopurine vs 5‐aminosalicylic acid | RR 1.05 [0.89, 1.24] | 4 studies · 347 participants | Low Downgraded: risk of bias |
Endoscopic relapse Azathioprine or 6‐mercaptopurine vs 5‐aminosalicylic acid | RR 0.78 [0.52, 1.17] | 1 study · 35 participants | Very low Downgraded: risk of bias |
Radiologic relapse Azathioprine or 6‐mercaptopurine vs 5‐aminosalicylic acid | RR 0.92 [0.66, 1.28] | 1 study · 35 participants | Very low Downgraded: risk of bias |
Surgical relapse Azathioprine or 6‐mercaptopurine vs 5‐aminosalicylic acid | RR 0.81 [0.5, 1.29] | 1 study · 142 participants | Very low Downgraded: risk of bias |
Adverse events Azathioprine or 6‐mercaptopurine vs 5‐aminosalicylic acid | RR 0.89 [0.74, 1.07] | 4 studies · 346 participants | Low Downgraded: risk of bias |
Serious adverse events Azathioprine or 6‐mercaptopurine vs 5‐aminosalicylic acid | RR 3.39 [1.26, 9.13] | 3 studies · 311 participants | Very low Downgraded: risk of bias |
Withdrawal due to adverse events Azathioprine or 6‐mercaptopurine vs 5‐aminosalicylic acid | RR 2.21 [1.28, 3.81] | 4 studies · 425 participants | Low Downgraded: risk of bias |
Azathioprine or 6‐mercaptopurine compared to anti TNF‐α for maintenance of surgically‐induced remission in Crohn's disease
Population: People with surgically‐induced remission in Crohn's disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical relapse Azathioprine or 6‐mercaptopurine vs anti TNF‐α | RR 2.89 [1.5, 5.57] | 3 studies · 139 participants | Very low Downgraded: risk of bias |
Endoscopic relapse Azathioprine or 6‐mercaptopurine vs anti TNF‐α | RR 3.67 [1.05, 12.81] | 4 studies · 157 participants | Very low Downgraded: risk of bias |
Radiologic relapse Azathioprine or 6‐mercaptopurine vs anti TNF‐α | no estimate extracted | 2 studies · 117 participants | Ungraded |
Surgical relapse Azathioprine or 6‐mercaptopurine vs anti TNF‐α | no estimate extracted | NR | No studies |
Adverse events Azathioprine or 6‐mercaptopurine vs anti TNF‐α | RR 1.13 [0.83, 1.53] | 2 studies · 117 participants | Low Downgraded: risk of bias |
Serious adverse events Azathioprine or 6‐mercaptopurine vs anti TNF‐α | RR 0.51 [0.17, 1.54] | 1 study · 84 participants | Very low Downgraded: risk of bias |
Withdrawal due to adverse events Azathioprine or 6‐mercaptopurine vs anti TNF‐α | RR 3.97 [0.92, 17.22] | 3 studies · 139 participants | Low Downgraded: risk of bias |
Azathioprine or 6‐mercaptopurine versus placebo for maintenance of surgically‐induced remission in Crohn's disease
Population: Patients in remission after surgery for Crohn's disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical relapse Azathioprine or 6‐mercaptopurine vs placebo | RR 0.74 [0.58, 0.94] | 2 studies · 168 participants | Low Downgraded: risk of bias, imprecision |
Endoscopic relapse (6‐MP study) Azathioprine or 6‐mercaptopurine vs placebo | RR 0.4 [0.19, 0.83] | 1 study · 87 participants | Low Downgraded: imprecision |
Azathioprine or 6‐mercaptopurine versus 5‐aminosalicylic acid for maintenance of surgically‐induced remission in Crohn's disease
Population: Patients in remission after surgery for Crohn's disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical relapse Azathioprine or 6‐mercaptopurine vs 5‐aminosalicylic acid | RR 1.15 [0.99, 1.34] | 5 studies · 425 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Clinical relapse (sensitivity analysis excluding study that enrolled patients with endoscopic recurrence) Azathioprine or 6‐mercaptopurine vs 5‐aminosalicylic acid | RR 1.06 [0.91, 1.24] | 4 studies · 347 participants | Low Downgraded: risk of bias, imprecision |
Clinical relapse (subgroup analysis ‐ AZA studies only) Azathioprine or 6‐mercaptopurine vs 5‐aminosalicylic acid | RR 1.25 [1.04, 1.51] | 4 studies · 334 participants | Low Downgraded: risk of bias, imprecision |
Endoscopic relapse (AZA study) Azathioprine or 6‐mercaptopurine vs 5‐aminosalicylic acid | RR 0.78 [0.52, 1.17] | 1 study · 35 participants | Very low Downgraded: risk of bias, imprecision |
Endoscopic relapse (6‐MP study) Azathioprine or 6‐mercaptopurine vs 5‐aminosalicylic acid | RR 0.36 [0.18, 0.72] | 1 study · 91 participants | Low Downgraded: imprecision |
Azathioprine versus infliximab for maintenance of surgically‐induced remission in Crohn's disease
Population: Patients in remission after surgery for Crohn's disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical relapse Azathioprine vs infliximab | RR 2 [0.21, 18.98] | 1 study · 22 participants | Very low Downgraded: risk of bias, imprecision |
Endoscopic relapse Azathioprine vs infliximab | RR 4.4 [0.59, 33.07] | 1 study · 21 participants | Very low Downgraded: risk of bias, imprecision |
Azathioprine versus adalimumab for maintenance of surgically‐induced remission in Crohn's disease
Population: Patients in remission after surgery for Crohn's disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical relapse Azathioprine vs adalimumab | RR 5.18 [1.35, 19.83] | 1 study · 33 participants | Very low Downgraded: risk of bias, imprecision |
Endoscopic relapse (6‐MP study) Azathioprine vs adalimumab | RR 10.35 [1.5, 71.32] | 1 study · 33 participants | Very low Downgraded: risk of bias, imprecision |