Journal of Gastrointestinal & Digestive System
Open Access

Abstract

Background: 6-MP is an immunomodulatory medication frequently prescribed for the induction and maintenance of remission in patients with moderately to severely active Crohnâ??s disease. Although symptomatic improvement has been shown in a proportion of patients with Crohnâ??s disease taking 6-MP, there is a paucity of data confirming improvement in the degree of mucosal disease in patients receiving this medication. The aim of this study was to determine the degree of endoscopic mucosal healing in a group of pediatric patients treated for Crohnâ??s disease with 6-MP without the use of a biologic agent. Methods: A retrospective review of the medical records of pediatric patients started on 6-MP for Crohnâ??s ileitis and/or colitis was performed. The Pediatric Crohnâ??s Disease Activity Index (PCDAI) score and Simple Endoscopic Score for Crohnâ??s Disease (SES-CD) were determined for all subjects at the time they initiated therapy with 6-MP and at least 6 months thereafter. Patients placed on 6-MP as a post-operative prophylactic agent were excluded. Results: Thirteen children aged 8 to 16 years at the time of diagnosis, met inclusion criteria. The total daily dosage of 6-MP ranged from 1-1.5 mg/kg (mean=1.1 mg/kg), and the duration of therapy between their initial and surveillance colonoscopies ranged from 2 to 36 months (mean=12.4 months). Seven of the 13 patients (54%) discontinued usage of 6-MP due to perceived failure to respond to treatment. Interestingly, only 4 of these 7 patients experienced an increase in their PCDAI score while taking 6-MP and only 2 of these 7 showed an increase in their SES-CD. Of the 6 patients who continued on therapy following their surveillance endoscopic procedures, all experienced an improvement of their PCDAI score, while only 3 patients showed an improvement in their SES-CD. Conclusions: In this small cohort of pediatric patients with moderate or severe Crohnâ??s disease treated with 6-MP, more than half discontinued therapy within 3 years of treatment. The clinical symptoms and laboratory results that comprise the PCDAI score do not seem to correlate well with the SES-CD score. 6-MP may have been stopped prematurely in some patients.

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