Switching to a Second Thiopurine in Adult and Elderly Patients With Inflammatory Bowel Disease: A Nationwide Study From the ENEIDA Registry
| Autor: | Margalida, Calafat, Míriam, Mañosa, Francisco, Mesonero, Jordi, Guardiola, Miguel, Mínguez, Pilar, Nos, Isabel, Vera, Carlos, Taxonera, Eva, Iglesias, Elena, Ricart, Javier P, Gisbert, Xavier, Calvet, Santiago, García-López, David, Monfort, José Lázaro, Pérez Calle, Sabino, Riestra, Fernando, Gomollón, Esther, Garcia-Planella, Fernando, Bermejo, Vicent, Hernández, María Dolores, Martín-Arranz, Ana, Gutiérrez, Paola, Torres, Fiorella, Cañete, Eugeni, Domènech, Zabana, Yamile |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Drug-Related Side Effects and Adverse Reactions Concordance Inflammatory bowel disease elderly 03 medical and health sciences 0302 clinical medicine inflammatory bowel disease Internal medicine Azathioprine medicine Humans 030212 general & internal medicine Practice Patterns Physicians' Adverse effect Thiopurine elderly inflammatory bowel disease Aged Thiopurine methyltransferase biology Thiopurine business.industry Drug Substitution Mercaptopurine Gastroenterology Age Factors General Medicine Odds ratio Drug Tolerance medicine.disease Inflammatory Bowel Diseases Confidence interval digestive system diseases Clinical Practice Spain biology.protein Acute pancreatitis 030211 gastroenterology & hepatology Female Risk Adjustment Drug Monitoring business Immunosuppressive Agents |
| Zdroj: | Journal of Crohns & Colitis r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau instname Journal of Crohn's & colitis r-IIS La Fe. Repositorio Institucional de Producción Científica del Instituto de Investigación Sanitaria La Fe r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA JOURNAL OF CROHNS & COLITIS r-IGTP. Repositorio Institucional de Producción Científica del Instituto de Investigación Germans Trias i Pujol r-IIB SANT PAU: Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau Institut dInvestigació Biomèdica Sant Pau (IIB Sant Pau) r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante |
| ISSN: | 1873-9946 1876-4479 |
| Popis: | 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 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 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. |
| Databáze: | OpenAIRE |
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