LONG-TERM EXPERIENCE WITH 6-MERCAPTOPURINE IN THE TREATMENT OF CROHNS-DISEASE

We report our observations after 20 yr of clinical experience with 6-m ercaptopurine (6-MP) in 148 patients with Crohn's disease who had not satisfactorily responded to steroids and other drugs. Specific therape utic goals were established for each patient, and the NFIC (now CCFA)- IOIBD index of Crohn's disease activity was calculated pre- and post-t herapy. Defined therapeutic goals were achieved in 68%. Major successe s include 1) elimination of steroids (66% p < 0.001); 2) healing of in ternal fistulas and abscesses or improvement by elimination of dischar ge and tenderness (64% p < 0.05); and 3) healing or improvement by eli mination of pain, tenderness and discharge of perirectal fistulas and abscesses (87%, p < 0.05). Other therapeutic goals which achieved 100% success were 1) healing or marked improvement of Crohn's disease of t he stomach and duodenum; 2) permitting surgery to be performed electiv ely after 6-MP allowed margins for surgical resection to be delineated . 6-MP was less effective in achieving the therapeutic goals of preven ting recurrent small bowel obstruction (43%) and elimination of abdomi nal masses (55%). Seventy-eight percent of patients showed a reduction in the activity index with a mean of 43% (95% C.I. 36-51%). 6-MP was once again demonstrated to be effective in achieving major therapeutic goals in two of three patients with severe Crohn's disease. According ly, the need for surgical resection and subsequent extension of the di sease is often postponed or eliminated.