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OBJECTIVES:

The efficacy of thiopurines (TPs) in altering the risk of surgery in Crohn's disease (CD) remains controversial. We evaluated the impact of TP therapy, optimal timing, and duration of TP therapy on first intestinal resection rates using a population-based cohort.

METHODS:

We constructed a population-based cohort of incident cases of CD between 1989 and 2005. We used the Kaplan–Meier analysis to calculate time trends in TP use and first intestinal resection in three groups defined by time period of diagnosis: 1989–1993, 1994–1999, and 2000–2005 groups A, B, and C, respectively. We quantified impact of duration and timing of TP treatment on likelihood of surgery using Cox regression and propensity score matching.

RESULTS:

We identified 5,640 eligible patients with CD. The 5-year cumulative probability of TP use increased from 12, 18, to 25%(P< 0.0001) while probability of first intestinal …