A multicenter trial of 6-mercaptopurine and prednisone in children with newly diagnosed Crohn's disease

Background & Aims: Clinical experience suggests that 6-mercaptopurine (6-MP ) is effective therapy for children with active steroid-dependent Crohn's d isease (CD). We report the results of a prospective, placebo-controlled, mu lticenter trial evaluating the combination of 6-MP and prednisone as therap y for children with newly diagnosed moderate-to-severe CD, Methods: Fifty-f ive children (age, 13 +/- 2 years) were randomized to treatment with 6-MP ( 1.5 mg.kg(-1).day(-1)) or placebo within 8 weeks of initial diagnosis, Both groups also received prednisone (40 mg/day), Prednisone dosage adjustments were based on a defined schedule determined by the change in a subject's d isease activity score, and steroid administration was discontinued as remis sion was achieved, Study treatment with 6-MP or placebo continued for 18 mo nths. Results: Groups were comparable for age, sex, and site and activity o f disease. In the 6-MP group, the duration of steroid use was shorter (P < 0.001) and the cumulative steroid dose lower at 6, 12, and 18 months (P < 0 .01), Although remission was induced in 89% of both groups, only 9% of the remitters in the 6-MP group relapsed compared with 47% of controls (P = 0.0 07), Growth was comparable in both groups, No clinically significant advers e events occurred, although mild leukopenia and increases in aminotransfera se activity were noted in the 6-MP group, Conclusions: Addition of 6-MP to a regimen of corticosteroids significantly lessens the need for prednisone and improves maintenance of remission. 6-MP should be part of the initial t reatment regimen for children with newly diagnosed moderate-to-severe CD,