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Mercaptopurine treatment should be considered in azathioprine intolerant patients with inflammatory bowel disease

Hindorf, U., Johansson, M., Eriksson, A., Kvifors, E. & Almer, S. H. C., 15-Mar-2009, In : Alimentary Pharmacology & Therapeutics. 29, 6, p. 654-661 8 p.

Research output: Contribution to journalArticleAcademicpeer-review

  • U. Hindorf
  • M. Johansson
  • A. Eriksson
  • E. Kvifors
  • S. H. C. Almer

Adverse drug reactions are a significant reason for therapeutic failure during thiopurine treatment of inflammatory bowel disease. Some smaller series in this patient population have shown that a switch to mercaptopurine may be successful in many cases of azathioprine intolerance.

To assess the long-term outcome of mercaptopurine treatment in a large patient population with azathioprine intolerance.

We identified 135 patients (74 women; median age 40 years) with Crohn's disease (n = 88) or ulcerative colitis (n = 47) and reviewed their medical records.

A total of 70 patients (52%) tolerated mercaptopurine and were followed up for 736 (362-1080) days; 65 patients discontinued mercaptopurine due to adverse events after 25 (8-92) days. Mercaptopurine was tolerated in 71% (12/17) with hepatotoxicity and in 68% (13/19) with arthralgia/myalgia during azathioprine treatment. Previous abdominal surgery was more common in mercaptopurine intolerant patients [39/65 (60%) vs. 27/70 (39%); P = 0.02] and thiopurine methyltransferase activity was higher in mercaptopurine tolerant patients than in mercaptopurine intolerant patients [13.2 (11.4-15.3) vs. 11.8 (9.6-14.2) U/mL red blood cells; P = 0.04; n = 81].

A trial of mercaptopurine should be considered in azathioprine intolerance, as half of the patients tolerate a switch to mercaptopurine. Patients with hepatotoxicity or arthralgia/myalgia during azathioprine treatment might benefit more often than those with other types of adverse events.

Original languageEnglish
Pages (from-to)654-661
Number of pages8
JournalAlimentary Pharmacology & Therapeutics
Volume29
Issue number6
Publication statusPublished - 15-Mar-2009

    Keywords

  • THIOPURINE METHYLTRANSFERASE ACTIVITY, CROHNS-DISEASE, SUCCESSFUL DESENSITIZATION, ULCERATIVE-COLITIS, 6-MERCAPTOPURINE, THERAPY, IDENTIFICATION, POPULATION, VARIANTS, TOXICITY

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