PMID- 27158876
OWN - NLM
STAT- MEDLINE
DCOM- 20171129
LR  - 20171226
IS  - 1536-3694 (Electronic)
IS  - 0163-4356 (Linking)
VI  - 38
IP  - 4
DP  - 2016 Aug
TI  - Clinical Value of Mercaptopurine After Failing Azathioprine Therapy in Patients 
      With Inflammatory Bowel Disease.
PG  - 463-70
LID - 10.1097/FTD.0000000000000312 [doi]
AB  - BACKGROUND: Thiopurines have been widely accepted as immunosuppressive therapy in 
      inflammatory bowel disease. However, many patients have to discontinue 
      thiopurines due to intolerance or ineffectiveness. A therapeutically beneficial 
      effect of switching from azathioprine (AZA) to mercaptopurine (MP) after 
      developing adverse events (AEs) has been reported. The authors assessed the 
      clinical value of MP therapy after AZA discontinuation due to intolerance and, 
      secondary, due to ineffectiveness. METHODS: In this retrospective single-center 
      study, the authors analyzed data from patients in whom AZA therapy had failed and 
      who were subsequently treated with MP. RESULTS: Thirty-eight patients initiated 
      MP therapy after intolerance to AZA. Intolerance reoccurred in 22 (58%) patients 
      and the remaining 16 (42%) tolerated MP. In 18 out of 48 patients (38%), the AEs 
      that led to discontinuation of MP were similar to those of AZA. A longer duration 
      of prior AZA use was more common in patients who were subsequently tolerant for 
      MP (5.3 versus 1.2 months; P = 0.04). Twenty-two patients discontinued AZA due to 
      ineffectiveness. Eight (36%) patients had clinical benefit from a switch to MP. 
      Six out of these 8 (75%) patients used allopurinol alongside MP, due to 
      ineffectiveness based on a skewed thiopurine metabolism. Patients were more 
      likely to have clinical benefit if the interval between both thiopurines was 
      longer (4.4 versus 0.01 months; P < 0.05). CONCLUSIONS: The authors showed that a 
      noteworthy number of patients benefitted therapeutically from a switch from AZA 
      to MP when failing due to intolerance or ineffectiveness; however, the percentage 
      was lower than previously reported in literature.
FAU - Meijer, Berrie
AU  - Meijer B
AD  - *Department of Gastroenterology and Hepatology, VU University Medical Center, 
      Amsterdam; and daggerDepartment of Gastroenterology, Geriatrics, Internal and 
      Intensive Care Medicine (Co-MIK), Zuyderland Medical Center, 
      Heerlen-Sittard-Geleen, the Netherlands.
FAU - Seinen, Margien L
AU  - Seinen ML
FAU - Leijte, Niek N W
AU  - Leijte NN
FAU - Mulder, Chris J J
AU  - Mulder CJ
FAU - van Bodegraven, Adriaan A
AU  - van Bodegraven AA
FAU - de Boer, Nanne K H
AU  - de Boer NK
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Ther Drug Monit
JT  - Therapeutic drug monitoring
JID - 7909660
RN  - 0 (Immunosuppressive Agents)
RN  - 63CZ7GJN5I (Allopurinol)
RN  - E7WED276I5 (Mercaptopurine)
RN  - MRK240IY2L (Azathioprine)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Allopurinol/therapeutic use
MH  - Azathioprine/*therapeutic use
MH  - Female
MH  - Humans
MH  - Immunosuppressive Agents/*therapeutic use
MH  - Inflammatory Bowel Diseases/*drug therapy
MH  - Male
MH  - Mercaptopurine/*therapeutic use
MH  - Retrospective Studies
MH  - Young Adult
EDAT- 2016/05/10 06:00
MHDA- 2017/12/01 06:00
CRDT- 2016/05/10 06:00
PHST- 2016/05/10 06:00 [entrez]
PHST- 2016/05/10 06:00 [pubmed]
PHST- 2017/12/01 06:00 [medline]
AID - 10.1097/FTD.0000000000000312 [doi]
PST - ppublish
SO  - Ther Drug Monit. 2016 Aug;38(4):463-70. doi: 10.1097/FTD.0000000000000312.