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

BACKGROUND AND AIMS: 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 lar...

Descripción completa

Detalles Bibliográficos
Autores: Calafat, Margalida, Manosa, Miriam, Mesonero, Francisco, Guardiola, Jordi, Minguez, Miguel, Nos, Pilar, Vera, Isabel, Taxonera, Carlos, Iglesias, Eva, Ricart, Elena, Gisbert, Javier P, Calvet, Xavier, Garcia-Lopez, Santiago, Monfort, David, Perez Calle, Jose Lazaro, Riestra, Sabino, Gomollon, Fernando, Garcia-Planella, Esther, Bermejo, Fernando, Vicent, Hernandez, Martin-Arranz, Maria Dolores, Gutierrez, Ana, Torres, Paola, Canete, Fiorella, Domenech, Eugeni
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2020
País:España
Institución:INCLIVA
Repositorio:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
OAI Identifier:oai:incliva.fundanetsuite.com:p4491
Acceso en línea:https://incliva.portalinvestigacion.com/publicaciones/4491
Access Level:acceso abierto
Palabra clave:Thiopurine
inflammatory bowel disease
elderly
Descripción
Sumario:BACKGROUND AND AIMS: 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.; 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: A total of 1,278 patients (13% over 60 years of age) were switched to a second thiopurine. At 12 months, the cumulative probability of switch intolerance was 43%, while persistence with treatment was 49%. Independent risk factors of switch intolerance were age over 60 years (OR 1.49; 95%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: 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. © The Author(s) 2020. Published by Oxford University Press on behalf of European Crohns and Colitis Organisation. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Similares en LA Referencia