BACKGROUND: 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. AIM: To assess the long-term outcome of mercaptopurine treatment in a large patient population with azathioprine intolerance. METHODS: 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. RESULTS: 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]. CONCLUSIONS: 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.
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机译:背景:药物不良反应是硫嘌呤治疗炎性肠病期间治疗失败的重要原因。在该患者人群中,一些较小的研究表明,在许多硫唑嘌呤不耐受的病例中,使用巯基嘌呤可能是成功的。目的:评估硫唑嘌呤不耐受的大量患者中巯基嘌呤治疗的长期结果。方法:我们确定了135例克罗恩病(n = 88)或溃疡性结肠炎(n = 47)的患者(74名女性,中位年龄40岁),并查看了他们的病历。结果:共有70例患者(52%)耐受巯基嘌呤,并随访了736(362-1080)天。 25(8-92)天后,由于不良反应,有65名患者停用巯基嘌呤。在硫唑嘌呤治疗期间,巯基嘌呤的肝毒性耐受率为71%(12/17),关节痛/肌痛的耐受率为68%(13/19)。巯基嘌呤不耐受的患者较常行腹部手术[39/65(60%)对27/70(39%); P = 0.02],巯基嘌呤耐受患者的硫嘌呤甲基转移酶活性高于巯基嘌呤耐受患者[13.2(11.4-15.3)vs. 11.8(9.6-14.2)U / mL红细胞; P = 0.04; n = 81]。结论:硫唑嘌呤耐受性不佳时应考虑巯基嘌呤的试验,因为一半的患者耐受转用巯基嘌呤。硫唑嘌呤治疗期间具有肝毒性或关节痛/肌痛的患者可能比具有其他类型不良事件的患者受益更多。
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