Increased risk of thiopurine-related adverse events in elderly patients with IBD.
Journal
Alimentary pharmacology & therapeutics
ISSN: 1365-2036
Titre abrégé: Aliment Pharmacol Ther
Pays: England
ID NLM: 8707234
Informations de publication
Date de publication:
10 2019
10 2019
Historique:
received:
23
04
2019
revised:
27
05
2019
accepted:
20
07
2019
pubmed:
21
8
2019
medline:
19
5
2020
entrez:
21
8
2019
Statut:
ppublish
Résumé
Thiopurines are the most widely used immunosuppressants in IBD although drug-related adverse events (AE) occur in 20%-30% of cases. To evaluate the safety of thiopurines in elderly IBD patients METHODS: Cohort study including all adult patients in the ENEIDA registry who received thiopurines. Patients were grouped in terms of age at the beginning of thiopurine treatment, specifically in those who started thiopurines over 60 years or between 18 and 50 years of age. Thiopurine-related AEs registered in the ENEIDA database were compared. Out of 48 752 patients, 1888 started thiopurines when over 60 years of age and 15 477 under 50 years of age. Median treatment duration was significantly shorter for those who started thiopurines >60 years (13 [IQR 2-55] vs 32 [IQR 5-82] months; P < .001). Patients starting >60 years had higher rates of all types of myelotoxicity, digestive intolerance and hepatotoxicity. Thiopurines were discontinued due to AEs (excluding malignancies and infections) in more patients starting >60 years (67.2% vs 63.1%; P < .001). Elderly age and female sex were independent risk factors for most AEs. In elderly IBD patients, thiopurines are associated with an increased risk of non-infectious, non-neoplastic, AEs.
Sections du résumé
BACKGROUND
Thiopurines are the most widely used immunosuppressants in IBD although drug-related adverse events (AE) occur in 20%-30% of cases.
AIM
To evaluate the safety of thiopurines in elderly IBD patients METHODS: Cohort study including all adult patients in the ENEIDA registry who received thiopurines. Patients were grouped in terms of age at the beginning of thiopurine treatment, specifically in those who started thiopurines over 60 years or between 18 and 50 years of age. Thiopurine-related AEs registered in the ENEIDA database were compared.
RESULTS
Out of 48 752 patients, 1888 started thiopurines when over 60 years of age and 15 477 under 50 years of age. Median treatment duration was significantly shorter for those who started thiopurines >60 years (13 [IQR 2-55] vs 32 [IQR 5-82] months; P < .001). Patients starting >60 years had higher rates of all types of myelotoxicity, digestive intolerance and hepatotoxicity. Thiopurines were discontinued due to AEs (excluding malignancies and infections) in more patients starting >60 years (67.2% vs 63.1%; P < .001). Elderly age and female sex were independent risk factors for most AEs.
CONCLUSION
In elderly IBD patients, thiopurines are associated with an increased risk of non-infectious, non-neoplastic, AEs.
Substances chimiques
Immunosuppressive Agents
0
Mercaptopurine
E7WED276I5
Azathioprine
MRK240IY2L
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
780-788Subventions
Organisme : Takeda Pharmaceutical Company
Pays : International
Organisme : AbbVie Biotherapeutics
Pays : International
Organisme : Kern pharmaceuticals
Pays : International
Organisme : Merck Sharp and Dohme
Pays : International
Organisme : Amgen
Pays : International
Organisme : Pfizer
Pays : International
Investigateurs
Àgueda Abad
(À)
Guillermo Alcaín
(G)
Pedro Almela
(P)
Federico Argüelles
(F)
Lara Arias
(L)
Manuel Barreiro-de-Acosta
(M)
Yolanda Ber
(Y)
Fernando Bermejo
(F)
Luis Bujanda
(L)
David Busquets
(D)
Margalida Calafat
(M)
Xavier Calvet
(X)
Marta Calvo
(M)
Fiorella Cañete
(F)
Mara Charro
(M)
Marta Cimavilla
(M)
Eugeni Domènech
(E)
Ruth de Francisco
(R)
Orlando García-Bosch
(O)
Santiago García-López
(S)
Esther Garcia-Planella
(E)
Mariana-Fe García-Sepulcre
(MF)
Fernando Gomollón
(F)
Ana Gutiérrez
(A)
José M Huguet
(JM)
Eva Iglesias
(E)
Sam Khorrami
(S)
José Lázaro
(J)
Jesús Legido
(J)
Jordina Llaó
(J)
Alfredo J Lucendo
(AJ)
Rosa E Madrigal
(RE)
Míriam Mañosa
(M)
Lucía Márquez
(L)
M Dolores Martín-Arranz
(M)
Jesús Martínez-Cadilla
(J)
Pilar Martínez-Montiel
(P)
Olga Merino
(O)
Francisco Mesonero
(F)
Miguel Mínguez
(M)
David Monfort
(D)
María Mora
(M)
Carmen Muñoz-Villafranca
(C)
Pilar Nos
(P)
Javier P Gisbert
(JP)
Laura Ramos
(L)
Elena Ricart
(E)
Joan Riera
(J)
Montserrat Rivero
(M)
Antonio Rodríguez Pérez
(A)
Cristina Rodríguez Gutiérrez
(C)
Francisco Rodríguez-Moranta
(F)
Ainhoa Rodríguez-Pescador
(A)
Patricia Romero
(P)
Oscar Roncero
(O)
Eva Sesé
(E)
Carlos Taxonera
(C)
Ana M Trapero
(AM)
Manuel Van Domselaar
(M)
Milagros Vela
(M)
Benito Velayos
(B)
Cristina Verdejo
(C)
Yamile Zabana
(Y)
Commentaires et corrections
Type : ErratumIn
Informations de copyright
© 2019 John Wiley & Sons Ltd.
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