BACKGROUND: High frequency of incomplete or non-response to azathioprine (AZA) and/or mercaptopurine (MP) limit their use in Crohn's disease (CD). Non-adherence is considered to be of relevance for ineffectiveness. AIM: To assess adherence to thiopurines in CD out-patients treated in a single gastroenterology practice. METHODS: Patients were eligible for inclusion if they received AZA/MP for at least 3 months. After follow-up of 3 months, adherence to AZA/MP was assessed by quantitation of relevant thiopurine metabolite levels in red blood cells as well as by patients' self-report using standardized questionnaire. RESULTS: Sixty-five patients were prospectively included. Six patients (9.2%) had metabolite profiles indicative of non-adherence. Self-assessed questionnaire revealed non-adherence in four of 56 patients (7.1%). Therapeutic drug monitoring (TDM) and self-assessment as two independent methods had a concordance rate of 75%. Metabolite levels and self-assessed adherence were not significantly different between patients in remission compared with those with active disease. CONCLUSIONS: Out-patients with CD treated in a single gastroenterology practice had a satisfactory adherence (>90%) to thiopurine therapy. Different measures of adherence (TDM and self-report) applied to the same patient suggest comparable levels. TDM appears to be a reliable tool to assess adherence to thiopurines in clinical practice.
BACKGROUND: High frequency of incomplete or non-response to azathioprine (AZA) and/or mercaptopurine (MP) limit their use in Crohn's disease (CD). Non-adherence is considered to be of relevance for ineffectiveness. AIM: To assess adherence to thiopurines in CD out-patients treated in a single gastroenterology practice. METHODS:Patients were eligible for inclusion if they received AZA/MP for at least 3 months. After follow-up of 3 months, adherence to AZA/MP was assessed by quantitation of relevant thiopurine metabolite levels in red blood cells as well as by patients' self-report using standardized questionnaire. RESULTS: Sixty-five patients were prospectively included. Six patients (9.2%) had metabolite profiles indicative of non-adherence. Self-assessed questionnaire revealed non-adherence in four of 56 patients (7.1%). Therapeutic drug monitoring (TDM) and self-assessment as two independent methods had a concordance rate of 75%. Metabolite levels and self-assessed adherence were not significantly different between patients in remission compared with those with active disease. CONCLUSIONS: Out-patients with CD treated in a single gastroenterology practice had a satisfactory adherence (>90%) to thiopurine therapy. Different measures of adherence (TDM and self-report) applied to the same patient suggest comparable levels. TDM appears to be a reliable tool to assess adherence to thiopurines in clinical practice.
Authors: P de Graaf; N K H de Boer; D R Wong; S Karner; B Jharap; P M Hooymans; A I Veldkamp; C J J Mulder; A A van Bodegraven; M Schwab Journal: Br J Pharmacol Date: 2010-07 Impact factor: 8.739
Authors: Herma H Fidder; Maartje M J Singendonk; Mike van der Have; Bas Oldenburg; Martijn G H van Oijen Journal: World J Gastroenterol Date: 2013-07-21 Impact factor: 5.742
Authors: Ahmed F Hawwa; Jeff S Millership; Paul S Collier; Anthony McCarthy; Sid Dempsey; Carole Cairns; James C McElnay Journal: Eur J Clin Pharmacol Date: 2009-07-28 Impact factor: 2.953
Authors: Mark M T J Broekman; Marieke J H Coenen; Geert J Wanten; Corine J van Marrewijk; Wietske Kievit; Olaf H Klungel; André L M Verbeek; Dennis R Wong; Piet M Hooymans; Henk-Jan Guchelaar; Hans Scheffer; Luc J J Derijks; Marcel L Bouvy; Dirk J de Jong Journal: Eur J Gastroenterol Hepatol Date: 2018-02 Impact factor: 2.566