Therapy

• azathioprine
• methotrexate
• 6-mercaptopurine

Why?

• Antimetabolites increase the rate of remission ^a and reduce the steroid doses. ^a However patients need to be treated for up to 4 months before there is any clear benefit. ^a
• Adverse effects are common (including pancreatitis, leukopenia, nausea, abnormal LFTs and infection). ^a

Antimetabolites increase remission and reduce steroid doses but causes adverse effects

Patient	Treatment	Comparison	Outcome	CER	OR (95% CI)	NNT (95% CI)
active Crohn's disease a	azathioprine or 6-mercaptopurine	placebo	remission at 2-12 months	33%	2.43 (1.62 to 3.64)	5 (3 to 9)
			steroid-sparing at 2-12 months	33%	3.69 (2.12 to 6.42)	3 (2 to 5)
			adverse effects at 2-12 months	33%	3.44 (1.52 to 7.77)	-19 (-86 to -8)