{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T22:39:38Z","timestamp":1776379178544,"version":"3.51.2"},"reference-count":48,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2014,4,16]],"date-time":"2014-04-16T00:00:00Z","timestamp":1397606400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2014,6]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Post\u2010operative recurrence of Crohn's disease is an important management challenge, with 2\u2010year recurrence rates defined by clinical, endoscopic and radiological parameters of up to 77%, 64% and 49%. Clinical and severe endoscopic recurrence vary widely in controlled trials from 13% to 36% and 22% to 56% with thiopurine treatment or 0% and 9% with infliximab treatment respectively at 1\u00a0year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To provide a review of the evidence for thiopurine or anti\u2010<jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content> use in post\u2010operative Crohn's disease, and to assess the ability to identify those patients at highest risk of recurrent disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A literature search was undertaken using Medline, Embase and Cochrane databases to identify studies using search terms \u2018thiopurine\u2019, \u2018azathioprine\u2019, \u2018mercaptopurine\u2019, \u2018Infliximab\u2019, \u2018adalimumab\u2019, \u2018Anti\u2010<jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>\u2018, \u2018Crohn's disease\u2019, \u2018post\u2010operative\u2019 and \u2018recurrence\u2019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Trials to examine this important area have proved difficult to execute, with recruitment and retention of patients posing major challenges to randomised clinical trials. There have been four <jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>s of 433 patients of thiopurine therapy (with three meta\u2010analyses of these data), and one of anti\u2010<jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content> therapy involving 24 patients. Overall the efficacy data for thiopurine use in this setting are inconclusive, and other than smoking, there are no consistent predictors of post\u2010operative relapse.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>At present, evidence for routine use of thiopurine treatment in post\u2010operative <jats:styled-content style=\"fixed-case\">Crohn's disease<\/jats:styled-content> is heterogeneous and unconvincing. Stratification by risk of relapse emerges as a key challenge in post\u2010operative management that needs to be addressed, using clinical parameters and emerging biomarkers. The evidence for prophylactic anti\u2010<jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content> use is limited though promising, with its routine use guided by early assessment of relapse.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.12743","type":"journal-article","created":{"date-parts":[[2014,4,17]],"date-time":"2014-04-17T02:40:59Z","timestamp":1397702459000},"page":"1253-1265","source":"Crossref","is-referenced-by-count":44,"title":["Systematic review: the use of thiopurines or anti\u2010<scp>TNF<\/scp> in post\u2010operative Crohn's disease maintenance \u2013 progress and prospects"],"prefix":"10.1111","volume":"39","author":[{"given":"G. R.","family":"Jones","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Western General Hospital Edinburgh UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N. 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