Mercaptopurine treatment should be considered in azathioprine intolerant patients with inflammatory bowel disease
2009 (English)In: ALIMENTARY PHARMACOLOGY and THERAPEUTICS, ISSN 0269-2813, Vol. 29, no 6, 654-661 p.Article in journal (Refereed) Published
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 Crohns 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.
Place, publisher, year, edition, pages
2009. Vol. 29, no 6, 654-661 p.
National CategoryMedical and Health Sciences
IdentifiersURN: urn:nbn:se:liu:diva-16981DOI: 10.1111/j.1365-2036.2008.03925.xOAI: oai:DiVA.org:liu-16981DiVA: diva2:200877