Mercaptopurine and inflammatory bowel disease: the other thiopurine.
2016
Background: Data about use and effectiveness of mercaptopurine
in inflammatory bowel disease are relatively limited.
Aims: To assess the possible therapeutic indications, efficacy
and safety of mercaptopurine as an alternative to azathioprine in
inflammatory bowel disease.
Methods: Retrospective observational study in patients treated
with mercaptopurine in a total cohort of 1,574 patients with
inflammatory bowel disease.
Results: One hundred and fifty-two patients received mercaptopurine,
15.7% of these patients as an initial thiopurine, 5.3%
after azathioprine failure, and 79% after azathioprine intolerance.
In 52.6% of patients (n = 80), adverse effects of mercaptopurine
occurred, resulting in withdrawal in 49 of them. Mercaptopurine
was effective in 39% of cases (95% CI 31-48%). In the remaining
patients, failure was due mainly to withdrawal due to side effects
(55.1%) and therapeutic step-up (33.7%). The average total time
of mercaptopurine exposure was 36 months (IQR: 2-60). Myelotoxicity
with mercaptopurine was more common in patients with
intermediate TPMT activity than in those with normal activity (p
= 0.046).
Conclusions: In our setting, mercaptopurine is primarily used
as a rescue therapy in patients with azathioprine adverse effects.
This could explain its modest efficacy and the high rate of adverse
effects. However, this drug is still an alternative in this group of
patients, before a therapeutic step-up to biologics is considered.
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