{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T15:20:33Z","timestamp":1784042433483,"version":"3.55.0"},"reference-count":53,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2023,4,26]],"date-time":"2023-04-26T00:00:00Z","timestamp":1682467200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100007028","name":"Leona M. and Harry B. Helmsley Charitable Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007028","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Thiopurines and methotrexate have long been used to maintain remission in Crohn\u2019s disease [CD]. In this nationwide study, we aimed to compare the effectiveness and safety of these drugs in CD.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We used data from the epi-IIRN cohort, including all patients with CD diagnosed in Israel. Outcomes were compared by propensity-score matching and included therapeutic failure, hospitalisations, surgeries, steroid dependency, and adverse events.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of the 19264 patients diagnosed with CD since 2005, 3885 [20%] ever received thiopurines as monotherapy and 553 [2.9%] received methotrexate. Whereas the use of thiopurines declined from 22% in 2012\u20132015 to 12% in 2017\u20132020, the use of methotrexate remained stable. The probability of sustaining therapy at 1, 3, and 5 years was 64%, 51%, and 44% for thiopurines and 56%, 30%, and 23% for methotrexate, respectively [p\u2005&amp;lt;0.001]. Propensity-score matching, including 303 patients [202 with thiopurines, 101 with methotrexate], demonstrated a higher rate of 5-year durability for thiopurines [40%] than methotrexate [18%; p\u2005&amp;lt;0.001]. Time to steroid dependency [p\u2005=\u20050.9], hospitalisation [p\u2005=\u20050.8], and surgery [p\u2005=\u20050.1] were comparable between groups. These outcomes reflect also shorter median time to biologics with methotrexate (2.2 [IQR 1.6\u20133.1 years) versus thiopurines (6.6 [2.4\u20138.5]; p\u2005=\u20050.02). The overall adverse events rate was higher with thiopurines [20%] than methotrexate [12%; p\u2005&amp;lt;0.001], including three lymphoma cases in males, although the difference was not significant [4.8 vs 0 cases\/10 000 treatment-years, respectively; p\u2005=\u20050.6].<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Thiopurines demonstrated higher treatment durability than methotrexate but more frequent adverse events. However, disease outcomes were similar, partly due to more frequent escalation to biologics with methotrexate.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ecco-jcc\/jjad076","type":"journal-article","created":{"date-parts":[[2023,4,26]],"date-time":"2023-04-26T19:53:32Z","timestamp":1682538812000},"page":"1614-1623","source":"Crossref","is-referenced-by-count":8,"title":["Thiopurines Have Longer Treatment Durability than Methotrexate in Adults and Children with Crohn\u2019s Disease: A Nationwide Analysis from the epi-IIRN Cohort"],"prefix":"10.1093","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7800-1984","authenticated-orcid":false,"given":"Ohad","family":"Atia","sequence":"first","affiliation":[{"name":"Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, Hebrew University of Jerusalem , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chagit","family":"Friss","sequence":"additional","affiliation":[{"name":"Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, Hebrew University of Jerusalem , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natan","family":"Ledderman","sequence":"additional","affiliation":[{"name":"Meuhedet Health Services , Tel-Aviv , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shira","family":"Greenfeld","sequence":"additional","affiliation":[{"name":"Maccabi Health Services, Tel-Aviv, Israel and the Sackler Faculty of Medicine, Tel Aviv University , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Revital","family":"Kariv","sequence":"additional","affiliation":[{"name":"Maccabi Health Services, Tel-Aviv, Israel and the Sackler Faculty of Medicine, Tel Aviv University , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saleh","family":"Daher","sequence":"additional","affiliation":[{"name":"Israel Defense Forces Medical Corps, Department of Medical Services, Jerusalem, Israel and Hadadsah-Hebrew University Medical Center, Institute of Gastrointestinal and Liver Diseases , Jerusalem , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henit","family":"Yanai","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel, and the Sackler Faculty of Medicine, Tel Aviv University , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiska","family":"Loewenberg Weisband","sequence":"additional","affiliation":[{"name":"Clalit Health Services, Clalit Research Institute , Tel-Aviv , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eran","family":"Matz","sequence":"additional","affiliation":[{"name":"Leumit Health Services , Tel-Aviv , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris","family":"Dotan","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel, and the Sackler Faculty of Medicine, Tel Aviv University , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Turner","sequence":"additional","affiliation":[{"name":"Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, Hebrew University of Jerusalem , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,4,26]]},"reference":[{"key":"2023111012335520400_CIT0001","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1053\/gast.2000.18144","article-title":"A multicenter trial of 6-mercaptopurine and prednisone in children with newly diagnosed Crohn\u2019s 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