Randomised trial of mycophenolate mofetil versus azathioprine fortreatment of chronic active Crohns disease

摘要

BACKGROUND—Crohn's disease is a chronic inflammatory disease of the alimentary tract. Azathioprine is an effective agent in the management of chronic active Crohn's disease leading to long term remission of disease activity. Such treatment leads to limited efficacy or side effects in a small subset of patients.
AIMS—To compare efficacy and side effects of treatment with azathioprine plus corticosteroids versus mycophenolate mofetil (MMF) plus corticosteroids in patients with chronic active Crohn's disease.
METHODS—Seventy patients with chronic active Crohn's disease (Crohn's disease activity index (CDAI) greater than 150) were randomised for treatment with azathioprine/cortisone or MMF/cortisone. Corticosteroid dosage was tapered according to a standard protocol. Disease activity was monitored by clinical scores after one, two, three, and six months.
RESULTS—Treatment of patients with moderately active (CDAI 150-300) Crohn's disease withMMF/cortisone led to a significant reduction in clinical activityscores comparable to treatment with azathioprine/cortisone. Treatmentof patients with highly active Crohn's disease (CDAI greater than 300)with MMF/cortisone caused significant suppression of clinical activityearlier than azathioprine/cortisone treatment. Treatment withMMF/cortisone was associated with few adverse effects.
CONCLUSION—Treatment of chronicactive Crohn's disease with MMF plus cortisone appears to be effectiveand well tolerated and should be considered in patients allergic toazathioprine or in whom azathioprine has failed.

Keywords:mycophenolate mofetil; azathioprine; Crohn'sdisease