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

J Crohns Colitis. 2020 Sep 16;14(9):1290-1298. doi: 10.1093/ecco-jcc/jjaa055.

Abstract

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 <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.

Keywords: Thiopurine; elderly; inflammatory bowel disease.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Azathioprine* / administration & dosage
  • Azathioprine* / adverse effects
  • Drug Monitoring / methods
  • Drug Substitution* / methods
  • Drug Substitution* / statistics & numerical data
  • Female
  • Humans
  • Immunosuppressive Agents / administration & dosage
  • Immunosuppressive Agents / adverse effects
  • Inflammatory Bowel Diseases* / drug therapy
  • Inflammatory Bowel Diseases* / epidemiology
  • Male
  • Mercaptopurine* / administration & dosage
  • Mercaptopurine* / adverse effects
  • Practice Patterns, Physicians' / statistics & numerical data
  • Risk Adjustment / methods
  • Spain / epidemiology

Substances

  • Azathioprine
  • Immunosuppressive Agents
  • Mercaptopurine