A trial of mercaptopurine is a safe strategy in patients with inflammatory bowel disease intolerant to azathioprine: an observational study, systematic review and meta‐analysis. Issue 10 (5th October 2013)

• Record Type: Journal Article
• Authors: Kennedy, N. A.; Rhatigan, E.; Arnott, I. D. R.; Noble, C. L.; Shand, A. G.; Satsangi, J.; Lees, C. W.
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 38:Issue 10(2013)
• Page Start: 1255
• Page End: 1266
• Publication Date: 2013-10-05
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.12511
• Languages: English
• ISSNs: 0269-2813

Abstract

<abstract abstract-type="main" id="apt12511-abs-0001"> <title>Summary</title> <sec id="apt12511-sec-0001" sec-type="section"> <title>Background</title> <p>Thiopurines maintain remission and modify disease course in inflammatory bowel disease. Use is limited by intolerance and subsequent drug withdrawal in approximately 17% of patients treated with azathioprine. Previous case series have addressed the success rates of re‐treatment with mercaptopurine in these individuals.</p> </sec> <sec id="apt12511-sec-0002" sec-type="section"> <title>Aims</title> <p>To determine the rate of tolerance when trialling mercaptopurine in azathioprine‐intolerant patients and the factors predictive of success, and to perform a systematic review and meta‐analysis of these data with other published data sets.</p> </sec> <sec id="apt12511-sec-0003" sec-type="section"> <title>Methods</title> <p>A retrospective observational study of 149 patients with IBD (82 with Crohn's disease and 67 with ulcerative colitis) previously intolerant of azathioprine subsequently treated with mercaptopurine was performed. A meta‐analysis was undertaken of all published studies of mercaptopurine use in azathioprine‐intolerant patients (455 patients in 11 included studies).</p> </sec> <sec id="apt12511-sec-0004" sec-type="section"> <title>Results</title> <p>Mercaptopurine was tolerated by 58% of azathioprine‐intolerant patients in the Edinburgh cohort. In the meta‐analysis, 68% tolerated mercaptopurine. A higher proportion of those in the meta‐analysis with GI toxicity (62%) or hepatotoxicity (81%) were able to tolerate mercaptopurine than those with flu‐like illness (36%). Among those patients who ceased mercaptopurine for further adverse effects, 59% experienced the same adverse effect as they had with azathioprine.</p> </sec> <sec id="apt12511-sec-0005" sec-type="section"> <title>Conclusions</title> <p>This meta‐analysis shows that switching to mercaptopurine is a safe therapeutic strategy for over two‐thirds of azathioprine‐intolerant patients and may help optimise immunomodulatory therapy in inflammatory bowel disease. A trial of mercaptopurine should be attempted in IBD patients (except those with acute pancreatitis or bone marrow aplasia) before considering thiopurine intolerance.</p> </sec> </abstract>