The use of azathioprine in Crohn’s disease during pregnancy and in the post-operative setting: a worldwide survey of experts
Article first published online: 20 JAN 2011
© 2011 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 33, Issue 6, pages 707–713, March 2011
How to Cite
Peyrin-Biroulet, L., Oussalah, A., Roblin, X. and Sparrow, M. P. (2011), The use of azathioprine in Crohn’s disease during pregnancy and in the post-operative setting: a worldwide survey of experts. Alimentary Pharmacology & Therapeutics, 33: 707–713. doi: 10.1111/j.1365-2036.2011.04577.x
- Issue published online: 14 FEB 2011
- Article first published online: 20 JAN 2011
- Publication data Submitted 14 December 2010 First decision 27 December 2010 Resubmitted 31 December 2010 Accepted 31 December 2010 EV Pub Online 20 January 2011
Aliment Pharmacol Ther 2011; 33: 707–713
Background Although thiopurines are considered safe in humans, they are still pregnancy FDA category D drugs. Prevention of post-operative recurrence is a challenge in clinical practice in Crohn’s disease. The European Crohn’s and Colitis Organisation consensus states that thiopurines should be considered in high-risk patients.
Aim To perform a worldwide survey for evaluating the extent to which gastroenterologists who are experts in the field of IBD are utilising thiopurines during pregnancy and in the post-operative setting in Crohn’s disease.
Methods This was a Web-based cross-sectional, statement-based survey, which was conducted among experts who have published at least once in the field of thiopurines in IBD.
Results Between 20 December 2009 and 9 April 2010, 175 questionnaires were received. The median number of IBD patients per physician per year was 400 (IQR 25–75th, 188–600) and the total number of IBD patients followed by all responders was 82 379. In a pregnant woman with a history of severe Crohn’s disease in clinical remission after 1 year on azathioprine, 89% of experts usually continue azathioprine until delivery and 9% of physicians never administrate azathioprine during pregnancy. After ileocecal resection for Crohn’s disease, 39% of physicians initiate azathioprine only in high-risk patients, 28% of practitioners prescribe azathioprine according to endoscopic evaluation, 20% of gastroenterologists systematically initiate azathioprine and 13% have a different attitude.
Conclusions Almost 9 of 10 physicians continue azathioprine throughout pregnancy. About 7 of 10 physicians prescribe azathioprine in the post-operative setting according to the European Crohn’s and Colitis Organisation recommendations, whereas one-fifth of practitioners systematically initiate azathioprine after surgery.