Adverse events of thiopurine immunomodulators in patients with inflammatory bowel disease

被引:28
作者
Lopez-Martin, Cristina
Chaparro, Maria
Espinosa, Laura
Bejerano, Alicia
Mate, Jose
Gisbert, Javier P. [1 ]
机构
[1] Hosp Univ La Princesa, Gastroenterol Unit, Inst Invest Sanitaria Princesa IP, Madrid, Spain
来源
GASTROENTEROLOGIA Y HEPATOLOGIA | 2011年 / 34卷 / 06期
关键词
Inflammatory bowel disease; Azathioprine; Mercaptopurine; Thiopurine; Adverse events; Myelotoxicity; Hepatotoxicity; Pancreatitis; NODULAR REGENERATIVE HYPERPLASIA; AZATHIOPRINE-INDUCED PANCREATITIS; INDUCED LIVER-INJURY; LONG-TERM TOXICITY; CROHNS-DISEASE; ULCERATIVE-COLITIS; 6-MERCAPTOPURINE; 6-THIOGUANINE; EXPERIENCE; THERAPY;
D O I
10.1016/j.gastrohep.2011.03.023
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background: Thiopurine immunomodulators are the most commonly used innmunosuppressants 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 MR 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. (C) 2011 Elsevier Espana, S.L. All rights reserved.
引用
收藏
页码:385 / 392
页数:8
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