Thiopurine therapy in inflammatory bowel disease patients: Analyses of two 8-year intercept cohorts

Abstract

Azathioprine and 6-mercaptopurine were considered effective in approximately 40% of IBD patients after 5 years of treatment. A quarter of the patients discontinued thiopurines within 3 months, mostly due to adverse events. A high 6-MMP concentration or 6-MMP/6-TGN ratio was associated with therapeutic failure. If thiopurine use was successfully initiated in the first months, its use was usually extended over many years, as long-term use was associated with continuation of therapy.

The use of azathioprine in Crohn’s disease during pregnancy and in the post-operative setting: a worldwide survey of experts

“…Indeed, in an 8-year intercept cohort of previous or present thiopurine-using IBD patients, a quarter of the patients discontinued thiopurines within 3 months, mostly due to adverse events; however, if thiopurine use was successfully initiated in the first months, its use was usually extended over many years. 21 In conclusion, this is the first worldwide IBD expert, statement-based survey that provided information on the extent of use of azathioprine in two clinical situations frequently encountered in clinical practice. During pregnancy, it seems obvious that almost all the experts are unanimous on continued treatment with thiopurines throughout pregnancy.…”

Hematologic Indices as Surrogate Markers for Monitoring Thiopurine Therapy in IBD

“…At least 9 % of IBD patients are primary non-responders to thiopurines [5]. In addition, treatment with thiopurines is potentially associated with significant rates of loss of response over time [6].…”

The effect of allopurinol and low-dose thiopurine combination therapy on the activity of three pivotal thiopurine metabolizing enzymes: Results from a prospective pharmacological study

“…Treatment withdrawal is mostly due to the development of adverse drug reactions or therapy resistance, allegedly related to an aberrant metabolism, which seems theoretically disadvantageous. 1,2 Several enzymes, of which the activities are partly pharmacogenetically determined, are crucial in the complex metabolism of thiopurines. 3 Among these enzymes are: hypoxanthine-guanine phosphoribosyl transferase (HGPRT), xanthine oxidase (XO) and thiopurine S-methyl transferase (TPMT).…”