Incidence of Myelotoxicity and Other Adverse Effects Related to Thiopurine Starting in Patients with Inflammatory Bowel Disease: Retrospective Observational Study in a Third-Level Hospital.
adverse effects neutropenia
azathioprine
inflammatory bowel disease
mercaptopurine
thiopurine methyltrasferase
thiopurines
Journal
Journal of clinical medicine
ISSN: 2077-0383
Titre abrégé: J Clin Med
Pays: Switzerland
ID NLM: 101606588
Informations de publication
Date de publication:
17 Oct 2023
17 Oct 2023
Historique:
received:
14
09
2023
revised:
09
10
2023
accepted:
15
10
2023
medline:
28
10
2023
pubmed:
28
10
2023
entrez:
28
10
2023
Statut:
epublish
Résumé
Thiopurines are an effective treatment for the maintenance of remission in inflammatory bowel disease (IBD). They can present adverse effects (AEs), with myelotoxicity being the most relevant. This study aims to determine the incidence of AEs related to the starting of thiopurines in our centre. Retrospective study. The AEs in patients that were started on thiopurines between January 2016 and June 2020 were registered, with a two-year follow-up. The mean and standard deviation were used to describe the quantitative variables, and percentages and confidence intervals were used for the qualitative variables. The statistical significance was set at a 98 patients were included, with 64 AEs detected in 48 patients (49%). Most of the AEs appeared in the first 6 months. The most relevant were: 21 neutropenia (21.4%), 19 hypertransaminasemia (19.4%), 13 digestive intolerances (13.2%), 6 acute pancreatitis (6.12%), 3 phototoxicity (3%), and 2 unknown origin fevers (2%). In 29 patients (29.4%) the treatment had to be suspended due to AEs. In 11 cases (11.2%), azathioprine (AZA) was switched to 6-mercaptopurine (6 MP) as 5 showed tolerance and 6 patients needed suspension due to AEs. Eight patients required hospital admission, but none of them needed intensive care unit admission. There were no fatal adverse effects. Thiopurines are a safe drug with few AEs, especially after the first months of treatment. These results suggest that periodic analytic follow-up may not be necessary after the initial period of treatment.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
Thiopurines are an effective treatment for the maintenance of remission in inflammatory bowel disease (IBD). They can present adverse effects (AEs), with myelotoxicity being the most relevant. This study aims to determine the incidence of AEs related to the starting of thiopurines in our centre.
METHODOLOGY
METHODS
Retrospective study. The AEs in patients that were started on thiopurines between January 2016 and June 2020 were registered, with a two-year follow-up. The mean and standard deviation were used to describe the quantitative variables, and percentages and confidence intervals were used for the qualitative variables. The statistical significance was set at a
RESULTS
RESULTS
98 patients were included, with 64 AEs detected in 48 patients (49%). Most of the AEs appeared in the first 6 months. The most relevant were: 21 neutropenia (21.4%), 19 hypertransaminasemia (19.4%), 13 digestive intolerances (13.2%), 6 acute pancreatitis (6.12%), 3 phototoxicity (3%), and 2 unknown origin fevers (2%). In 29 patients (29.4%) the treatment had to be suspended due to AEs. In 11 cases (11.2%), azathioprine (AZA) was switched to 6-mercaptopurine (6 MP) as 5 showed tolerance and 6 patients needed suspension due to AEs. Eight patients required hospital admission, but none of them needed intensive care unit admission. There were no fatal adverse effects.
CONCLUSIONS
CONCLUSIONS
Thiopurines are a safe drug with few AEs, especially after the first months of treatment. These results suggest that periodic analytic follow-up may not be necessary after the initial period of treatment.
Identifiants
pubmed: 37892708
pii: jcm12206571
doi: 10.3390/jcm12206571
pmc: PMC10607915
pii:
doi:
Types de publication
Journal Article
Langues
eng
Références
Visc Med. 2017 Mar;33(1):82-88
pubmed: 28612022
Aliment Pharmacol Ther. 2018 Apr;47(8):1092-1102
pubmed: 29468701
Aliment Pharmacol Ther. 2007 May 1;25(9):1069-77
pubmed: 17439508
J Crohns Colitis. 2018 Apr 27;12(5):610-620
pubmed: 29293971
Scand J Gastroenterol. 2017 Sep;52(9):981-987
pubmed: 28554266
Gastroenterology. 2008 Apr;134(4):929-36
pubmed: 18294633
Am J Gastroenterol. 2008 Jul;103(7):1783-800
pubmed: 18557712
Drugs Aging. 2021 Mar;38(3):193-203
pubmed: 33438138
Gastroenterol Hepatol. 2018 Mar;41(3):205-221
pubmed: 29357999
Drug Ther Bull. 2009 Jan;47(1):9-12
pubmed: 19129430
Rev Esp Enferm Dig. 2001 Dec;93(12):769-78
pubmed: 11995359
Br J Clin Pharmacol. 2014 Apr;77(4):704-14
pubmed: 23962279
JAMA. 2013 Nov 27;310(20):2191-4
pubmed: 24141714
Can J Gastroenterol. 2013 Jan;27(1):39-43
pubmed: 23378982
J Crohns Colitis. 2016 Jan;10(1):61-8
pubmed: 26468141
J Crohns Colitis. 2012 Jun;6(5):588-96
pubmed: 22398045
Pharmacogenetics. 2002 Aug;12(6):429-36
pubmed: 12172211
Aliment Pharmacol Ther. 2015 Apr;41(8):734-46
pubmed: 25728587