Adverse events of thiopurine immunomodulators in patients with inflammatory bowel disease.

Abstract

BACKGROUND:

Thiopurine immunomodulators are the most commonly used immunosuppressants in inflammatory bowel disease.

AIMS:

To evaluate the incidence of adverse events (AE) in patients with inflammatory bowel disease treated with azathioprine (AZA) or 6-mercaptopurine (MP) in our hospital, the features of these effects, the distribution of socio-demographic factors, and the possible predisposing factors.

METHODS:

We included 377 patients with inflammatory bowel disease who were diagnosed through 2008 and who received AZA or MP during the course of their disease. We collected retrospective demographic, clinical, and laboratory data about their disease and detailed information on any AE.

RESULTS:

Fifty-one patients had some form of AE with AZA or MP (13.5%) and 11% discontinued therapy because of toxicity. Statistically significant association with Crohn's disease was found (P = .008). Myelotoxicity occurred in 18 patients (4.8%) with a mean time of laboratory abnormalities appearing after 16 months. Nine patients had hepatotoxicity secondary to these drugs (2.4%); one of them developed nodular regenerative hyperplasia and portal hypertension. Ten patients had acute pancreatitis (2.7%) with a mean time occurrence of 27 days and a statistically significant association with Crohn's disease (P = .03) and smoking (P = .01). Fifteen patients had gastrointestinal intolerance (4%) but 5 were able to continue with medication given in divided doses or switching to MP.

CONCLUSIONS:

Thiopurine immunomodulators have a significant percentage of AE (13.5%), which, although usually mild, forced us to follow up all cases and sometimes even suspend treatment.

• Authors: Cristina López-Martín, María Chaparro, Laura Espinosa, Alicia Bejerano, José Maté, Javier P Gisbert
• Journal: Gastroenterologia y hepatologia (Gastroenterol Hepatol) 2011 Jun-Jul Vol. 34 Issue 6 Pg. 385-92 ISSN: 0210-5705 [Print] Spain
• PMID: 21616565 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2011 Elsevier España, S.L. All rights reserved.

Chemical References

• Immunosuppressive Agents
• Mercaptopurine
• Azathioprine

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Azathioprine (adverse effects)
• Humans
• Immunosuppressive Agents (adverse effects)
• Inflammatory Bowel Diseases (drug therapy)
• Mercaptopurine (adverse effects)
• Middle Aged
• Retrospective Studies
• Young Adult