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Azathioprine or Ileocolic Resection for Steroid-Dependent Terminal Ileal Crohn’s Disease? A Markov Analysis

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

INTRODUCTION

The objective of this study was to determine whether initial azathioprine therapy, followed by ileocolic resection if azathioprine fails, or initial ileocolic resection without a trial of azathioprine is the preferred treatment strategy in steroid-dependent, terminal ileal Crohn’s disease.

METHODS

A Markov, decision analytic model was developed to simulate a 36-month course for a patient with steroid-dependent, terminal ileal Crohn’s disease who would initially take azathioprine or have ileocolic resection. Clinically important outcomes in the model included side effects and effectiveness of azathioprine and postoperative complications, mortality, and recurrence following ileocolic resection. The probabilities and utilities for these variables were derived from previously published studies.

RESULTS

Initial azathioprine therapy offered a relatively small benefit of 0.45 quality-adjusted life-months over initial ileocolic resection. The model was sensitive to utility for being symptom-free on azathioprine and utility for being symptom-free postoperatively.

CONCLUSIONS

Initial azathioprine therapy and initial ileocolic resection are both reasonable treatment strategies in this setting. The preferred treatment strategy is highly dependent on the quality of life that can be achieved with each treatment option. Therefore, individual response and symptom control with each treatment must be strongly considered in this treatment decision.

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Authors and Affiliations

  1. Department of Surgery and Medicine, University of Toronto and the Samuel Lunenfield Research Institute, Mount Sinai Hospital, Toronto, Canada

    Erin D. Kennedy M.D., A. Hillary Steinhart M.D. & Zane Cohen M.D.

  2. Department of Health Policy, Management and Evaluation, University of Toronto and the Samuel Lunenfield Research Institute, Mount Sinai Hospital, Toronto, Canada

    David R. Urbach M.D., Murray D. Krahn M.D. & Robin S. McLeod M.D.

Authors
  1. Erin D. Kennedy M.D.
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  2. David R. Urbach M.D.
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  3. Murray D. Krahn M.D.
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  4. A. Hillary Steinhart M.D.
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  5. Zane Cohen M.D.
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  6. Robin S. McLeod M.D.
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Corresponding author

Correspondence to Robin S. McLeod M.D..

Additional information

Dr. Kennedy is supported by the Crohn’s and Colitis Foundation of Canada and the Medical Research Council of Canada.

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Kennedy, E., Urbach, D., Krahn, M. et al. Azathioprine or Ileocolic Resection for Steroid-Dependent Terminal Ileal Crohn’s Disease? A Markov Analysis. Dis Colon Rectum 47, 2120–2130 (2004). https://doi.org/10.1007/s10350-004-0725-6

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  • DOI: https://doi.org/10.1007/s10350-004-0725-6

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