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 17 January 2018

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News

How are azathioprine and mercaptopurine dosed by gastroenterologists?

The most recent issue of Inflammatory Bowel Disease considers how azathioprine and mercaptopurine are dosed by gastroenterologists.

News image

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Azathioprine, and mercaptopurine are accepted as effective therapy for Crohn's disease, and ulcerative colitis.

General guidelines have been suggested for weight-based dosing of thiopurines, however, no standard of care has been established.

Clinical trials have demonstrated efficacy for weight-based dosing of azathioprine at 2.5 mg/kg/day, and mercaptopurine at 1.5 mg/kg/day.

Escalation of dosing is recommended within 2 weeks of initiating therapy.

Dr Miles Sparrow and colleagues from Australia determined the prescribing practices of community practice gastroenterologists with respect to mercaptopurine/azathioprine dosing.

24% of gastroenterologists escalated the dose within 2 weeks after initiating therapy
Inflammatory Bowel Diseases

The research team distributed questionnaires via a mail database or during gastroenterology society meetings to gastroenterologists.

Questionnaires ascertained starting doses of azathioprine/mercaptopurine, use of thiopurine methyltransferase enzyme testing, and strategy for dose optimization.

The researchers collected 145 questionnaires.

A total of 24% of gastroenterologists escalated the dose within 2 weeks after initiating therapy.

The majority used weight-based dosing as their target of therapy.

The research team noted that 35% reported measuring thiopurine methyltransferase levels, and 46% used metabolite monitoring.

Dr Sparrow's team concluded, "Most gastroenterologists take longer than recommended to raise the dose of azathioprine/mercaptopurine."

"Although the majority of gastroenterologists reported maximal dosages based on weight, there may be a delay in achieving this goal."

"Optimizing dosing of azathioprine/mercaptopurine may improve efficacy, and reduce the need to use additional therapy."

Inflamm Bowel Dis 2008: 14(4): 514-8
26 March 2008

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