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News

Mercaptopurine trial is safe in patients with IBD intolerant to azathioprine

A trial of mercaptopurine is a safe strategy in patients with inflammatory bowel disease intolerant to azathioprine, reports the most recent issue of the Alimentary Pharmacology & Therapeutics.

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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.

Dr Lees and colleagues from the United Kingdom determined 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.

The researchers performed a retrospective observational study of 149 patients with IBD previously intolerant of azathioprine subsequently treated with mercaptopurine was performed.

68% tolerated mercaptopurine
Alimentary Pharmacology & Therapeutics

A meta-analysis was undertaken of all published studies of mercaptopurine use in azathioprine-intolerant patients.

The researchers found that 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 or hepatotoxicity were able to tolerate mercaptopurine than those with flu-like illness.

The team noted that among those patients who ceased mercaptopurine for further adverse effects, 59% experienced the same adverse effect as they had with azathioprine.

Dr Lees' team concludes, "This meta-analysis shows that switching to mercaptopurine is a safe therapeutic strategy for over two-thirds of azathioprine-intolerant patients and may help optimize immunomodulatory therapy in inflammatory bowel disease."

"A trial of mercaptopurine should be attempted in IBD patients before considering thiopurine intolerance."

Aliment Pharmacol Ther 2013: 38(10): 1255–1266
01 November 2013

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