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Mercaptopurine treatment should be considered in azathioprine intolerant patients with inflammatory bowel disease
Lund University Hospital.
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
Sahlgrens University Hospital.
Sahlgrens University Hospital.
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2009 (English)In: ALIMENTARY PHARMACOLOGY and THERAPEUTICS, ISSN 0269-2813, Vol. 29, no 6, 654-661 p.Article in journal (Refereed) Published
Abstract [en]

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 Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-16981DOI: 10.1111/j.1365-2036.2008.03925.xOAI: diva2:200877
Available from: 2009-03-01 Created: 2009-02-27 Last updated: 2009-08-18

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Almer, Sven
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Department of Clinical and Experimental MedicineFaculty of Health SciencesGastroenterology and Hepatology Department of Endocrinology and Gastroenterology UHL
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