Switching to a Second Thiopurine in Adult and Elderly Patients With Inflammatory Bowel Disease: A Nationwide Study From the ENEIDA Registry.

Adult Age Factors Aged Azathioprine / administration & dosage Drug Monitoring / methods Drug Substitution / methods Drug Tolerance Drug-Related Side Effects and Adverse Reactions / diagnosis Female Humans Immunosuppressive Agents / administration & dosage Inflammatory Bowel Diseases / drug therapy Male Mercaptopurine / administration & dosage Practice Patterns, Physicians' / statistics & numerical data Risk Adjustment / methods Spain / epidemiology

Thiopurine elderly inflammatory bowel disease

Journal

Journal of Crohn's & colitis

ISSN: 1876-4479

Titre abrégé: J Crohns Colitis

Pays: England

ID NLM: 101318676

Informations de publication

Date de publication:
16 Sep 2020

Historique:

pubmed: 24 3 2020

medline: 30 7 2021

entrez: 24 3 2020

Statut: ppublish

Résumé

Although commonly used in inflammatory bowel disease [IBD], thiopurines frequently cause intolerance, and switching to a second thiopurine has only been reported in some small series. Ours aims in this study were to evaluate the safety of switching to a second thiopurine in a large cohort, and to assess the impact of age on tolerance. Adult IBD patients from the ENEIDA registry, who were switched to a second thiopurine due to adverse events [excluding malignancies and infections], were identified. At the beginning of thiopurine treatment, patients were divided by age into two groups: 18-50 and over 60 years of age. The rate and concordance of adverse events between the first and second thiopurines, treatment intolerance, and persistence with the second thiopurine were evaluated. A total of 1278 patients [13% over 60 years of age] were switched to a second thiopurine. At 12 months, the cumulative probability of switch intolerance was 43%, and persistence with treatment was 49%. Independent risk factors of switch intolerance were age over 60 years (odds ratio [OR] 1.49; 95% confidence interval [CI] 1.07-2.07; p = 0.017) , previous gastrointestinal toxicity [OR 1.4; 95% CI 1.11-1.78; p = 0.005], previous acute pancreatitis [OR 6.78; 95% CI 2.55-18.05; p <0.001], and exposure to the first thiopurine <6 months [OR 1.59; 95% CI 1.14-2.23; p = 0.007]. In a large series in clinical practice, switching to a second thiopurine proved to be a valid strategy. Tight monitoring of elderly IBD patients switching to a second thiopurine because of adverse events is recommended.

Sections du résumé

BACKGROUND AND AIMS OBJECTIVE

METHODS METHODS

Adult IBD patients from the ENEIDA registry, who were switched to a second thiopurine due to adverse events [excluding malignancies and infections], were identified. At the beginning of thiopurine treatment, patients were divided by age into two groups: 18-50 and over 60 years of age. The rate and concordance of adverse events between the first and second thiopurines, treatment intolerance, and persistence with the second thiopurine were evaluated.

RESULTS RESULTS

A total of 1278 patients [13% over 60 years of age] were switched to a second thiopurine. At 12 months, the cumulative probability of switch intolerance was 43%, and persistence with treatment was 49%. Independent risk factors of switch intolerance were age over 60 years (odds ratio [OR] 1.49; 95% confidence interval [CI] 1.07-2.07; p = 0.017) , previous gastrointestinal toxicity [OR 1.4; 95% CI 1.11-1.78; p = 0.005], previous acute pancreatitis [OR 6.78; 95% CI 2.55-18.05; p <0.001], and exposure to the first thiopurine <6 months [OR 1.59; 95% CI 1.14-2.23; p = 0.007].

CONCLUSIONS CONCLUSIONS

In a large series in clinical practice, switching to a second thiopurine proved to be a valid strategy. Tight monitoring of elderly IBD patients switching to a second thiopurine because of adverse events is recommended.

Identifiants

DOI: 10.1093/ecco-jcc/jjaa055 PMID: 32201893

pubmed: 32201893

pii: 5810964

doi: 10.1093/ecco-jcc/jjaa055

doi:

Substances chimiques

Immunosuppressive Agents 0

Mercaptopurine E7WED276I5

Azathioprine MRK240IY2L

Types de publication

Journal Article Multicenter Study Observational Study

Langues

eng

Sous-ensembles de citation

Pagination

1290-1298

Investigateurs

Abad Águeda (A)

Alcaín Guillermo (A)

Almela Pedro (A)

H Federico Argüelles (H)

C H Manuel Barreiro-de-Acosta (CH)

Bermejo Fernando (B)

Bujanda Luis (B)

H David Busquets (H)

Calvet Xavier (C)

Cañete Fiorella (C)

H Mara Charro (H)

Cimavilla Marta (C)

Domènech Eugeni (D)

Manuel Van Domselaar (M)

García-López Santiago (GL)

Garcia-Planella Esther (GP)

García Sepulcre Mariana-Fe (GS)

Gomollón Fernando (G)

Guardiola Jordi (G)

Gutiérrez Ana (G)

Hernández Vicent (H)

M Huguet José (MH)

Iglesias Eva (I)

Khorrami Sam (K)

Legido Jesús (L)

Llaó Jordina (L)

J Lucendo Villarín Alfredo (JLV)

Eva Madrigal Rosa (EM)

Mañosa Míriam (M)

Márquez Lucía (M)

Dolores Martín-Arranz María (DM)

Martínez Montiel Pilar (MM)

Merino Olga (M)

Mesonero Francisco (M)

Mínguez Miguel (M)

Monfort David (M)

Mora Maria (M)

Muñoz Carmen (M)

García-Bosch Orlando (GB)

Nos Pilar (N)

Lázaro Pérez Calle José (LPC)

P Gisbert Javier (PG)

Ramos Laura (R)

Ricart Elena (R)

Riera Joan (R)

Riestra Sabino (R)

Rivero Montserrat (R)

Rodríguez Antonio (R)

Rodríguez Gutiérrez Cristina (RG)

H Ainhoa Rodríguez-Pescador (H)

Romero Patricia (R)

Roncero Óscar (R)

H Eva Sesé (H)

Torres Paola (T)

Vela Milagros (V)

Velayos Benito (V)

Vera Isabel (V)

Verdejo Cristina (V)

Zabana Yamile (Z)