Thiopurines in the Management of Crohn’s Disease: Safety and Efficacy Profile in Patients with Normal TPMT Activity—A Retrospective Study
Background and Aims. Thiopurines are used in the treatment of Crohn’s disease (CD) and thiopurine S-methyltransferase (TPMT) activity can guide thiopurine dosing to avoid adverse events. This retrospective study evaluated the safety and efficacy of starting thiopurines at low dose versus full dose i...
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| Format: | Article |
| Language: | English |
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Wiley
2016-01-01
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| Series: | Canadian Journal of Gastroenterology and Hepatology |
| Online Access: | http://dx.doi.org/10.1155/2016/1034834 |
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| author | Amine Benmassaoud Xuanqian Xie Motaz AlYafi Yves Theoret Alain Bitton Waqqas Afif Talat Bessissow |
| author_facet | Amine Benmassaoud Xuanqian Xie Motaz AlYafi Yves Theoret Alain Bitton Waqqas Afif Talat Bessissow |
| author_sort | Amine Benmassaoud |
| collection | DOAJ |
| description | Background and Aims. Thiopurines are used in the treatment of Crohn’s disease (CD) and thiopurine S-methyltransferase (TPMT) activity can guide thiopurine dosing to avoid adverse events. This retrospective study evaluated the safety and efficacy of starting thiopurines at low dose versus full dose in patients with CD and normal TPMT. Methods. This was a single center retrospective study including adult CD patients with normal TPMT levels (≥25 nmol/hr/g Hgb) who were followed for 1 year. Patients started at full dose of azathioprine (2–2.5 mg/kg) or 6-mercaptopurine (1–1.5 mg/kg) were compared to patients started at low dose. Harvey-Bradshaw index, treatment failure, and drug-related adverse events were recorded. Results. Our study included 134 patients. Both groups had similar incidences of drug-related adverse events and discontinuation of therapy due to side effects. Fifty-six percent of all adverse events occurred within 31 days and 92% occurred within 3 months of therapy. Clinical response favored the full-dose group at 6 months (69% versus 27%, p=0.0542). Conclusions. Our study indicates that it is safe to start patients on full-dose thiopurine when they have a normal TPMT given its very similar toxicity profile to patients started on low dose. This may also positively impact efficacy. |
| format | Article |
| id | doaj-art-25476ca7bb334521b64e6649b7101b59 |
| institution | Kabale University |
| issn | 2291-2789 2291-2797 |
| language | English |
| publishDate | 2016-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Canadian Journal of Gastroenterology and Hepatology |
| spelling | doaj-art-25476ca7bb334521b64e6649b7101b592025-02-03T05:52:13ZengWileyCanadian Journal of Gastroenterology and Hepatology2291-27892291-27972016-01-01201610.1155/2016/10348341034834Thiopurines in the Management of Crohn’s Disease: Safety and Efficacy Profile in Patients with Normal TPMT Activity—A Retrospective StudyAmine Benmassaoud0Xuanqian Xie1Motaz AlYafi2Yves Theoret3Alain Bitton4Waqqas Afif5Talat Bessissow6Division of Gastroenterology, McGill University Health Center, 1650 Cedar Avenue, C7-200, Montreal, QC, H3G 1A4, CanadaTechnology Assessment Unit, McGill University Health Center, 687 Pine Avenue West, Room R4.09, Montreal, QC, H3A 1A1, CanadaDivision of Gastroenterology, McGill University Health Center, 1650 Cedar Avenue, C7-200, Montreal, QC, H3G 1A4, CanadaUnite de Pharmacologie Clinique, Centre Hospitalier Universitaire de Sainte-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1C4, CanadaDivision of Gastroenterology, McGill University Health Center, 1650 Cedar Avenue, C7-200, Montreal, QC, H3G 1A4, CanadaDivision of Gastroenterology, McGill University Health Center, 1650 Cedar Avenue, C7-200, Montreal, QC, H3G 1A4, CanadaDivision of Gastroenterology, McGill University Health Center, 1650 Cedar Avenue, C7-200, Montreal, QC, H3G 1A4, CanadaBackground and Aims. Thiopurines are used in the treatment of Crohn’s disease (CD) and thiopurine S-methyltransferase (TPMT) activity can guide thiopurine dosing to avoid adverse events. This retrospective study evaluated the safety and efficacy of starting thiopurines at low dose versus full dose in patients with CD and normal TPMT. Methods. This was a single center retrospective study including adult CD patients with normal TPMT levels (≥25 nmol/hr/g Hgb) who were followed for 1 year. Patients started at full dose of azathioprine (2–2.5 mg/kg) or 6-mercaptopurine (1–1.5 mg/kg) were compared to patients started at low dose. Harvey-Bradshaw index, treatment failure, and drug-related adverse events were recorded. Results. Our study included 134 patients. Both groups had similar incidences of drug-related adverse events and discontinuation of therapy due to side effects. Fifty-six percent of all adverse events occurred within 31 days and 92% occurred within 3 months of therapy. Clinical response favored the full-dose group at 6 months (69% versus 27%, p=0.0542). Conclusions. Our study indicates that it is safe to start patients on full-dose thiopurine when they have a normal TPMT given its very similar toxicity profile to patients started on low dose. This may also positively impact efficacy.http://dx.doi.org/10.1155/2016/1034834 |
| spellingShingle | Amine Benmassaoud Xuanqian Xie Motaz AlYafi Yves Theoret Alain Bitton Waqqas Afif Talat Bessissow Thiopurines in the Management of Crohn’s Disease: Safety and Efficacy Profile in Patients with Normal TPMT Activity—A Retrospective Study Canadian Journal of Gastroenterology and Hepatology |
| title | Thiopurines in the Management of Crohn’s Disease: Safety and Efficacy Profile in Patients with Normal TPMT Activity—A Retrospective Study |
| title_full | Thiopurines in the Management of Crohn’s Disease: Safety and Efficacy Profile in Patients with Normal TPMT Activity—A Retrospective Study |
| title_fullStr | Thiopurines in the Management of Crohn’s Disease: Safety and Efficacy Profile in Patients with Normal TPMT Activity—A Retrospective Study |
| title_full_unstemmed | Thiopurines in the Management of Crohn’s Disease: Safety and Efficacy Profile in Patients with Normal TPMT Activity—A Retrospective Study |
| title_short | Thiopurines in the Management of Crohn’s Disease: Safety and Efficacy Profile in Patients with Normal TPMT Activity—A Retrospective Study |
| title_sort | thiopurines in the management of crohn s disease safety and efficacy profile in patients with normal tpmt activity a retrospective study |
| url | http://dx.doi.org/10.1155/2016/1034834 |
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