Abhinav Vasudevan1, Lauren Beswick2, Antony B Friedman3, Alicia Moltzen4, James Haridy5, Ajay Raghunath6, Miles Sparrow7, Daniel van Langenberg8. 1. Department of Gastroenterology and Hepatology, Eastern Health and Monash University, Box Hill Hospital, Box Hill, Victoria, Australia. Electronic address: abhinav.vasudevan@monash.edu. 2. Department of Gastroenterology and Hepatology, Eastern Health and Monash University, Box Hill Hospital, Box Hill, Victoria, Australia; Department of Gastroenterology, Alfred Health and Monash University, Victoria, Australia. Electronic address: laurenbeswick@hotmail.com. 3. Department of Gastroenterology, Alfred Health and Monash University, Victoria, Australia. Electronic address: a.friedman@alfred.org.au. 4. Department of Gastroenterology and Hepatology, Eastern Health and Monash University, Box Hill Hospital, Box Hill, Victoria, Australia. Electronic address: alicia.moltzen@monash.edu. 5. Department of Gastroenterology and Hepatology, Eastern Health and Monash University, Box Hill Hospital, Box Hill, Victoria, Australia. Electronic address: jamesharidy@gmail.com. 6. Department of Gastroenterology and Hepatology, Eastern Health and Monash University, Box Hill Hospital, Box Hill, Victoria, Australia. Electronic address: ajraghunath@gmail.com. 7. Department of Gastroenterology, Alfred Health and Monash University, Victoria, Australia. Electronic address: m.sparrow@alfred.org.au. 8. Department of Gastroenterology and Hepatology, Eastern Health and Monash University, Box Hill Hospital, Box Hill, Victoria, Australia. Electronic address: daniel.van-langenberg@monash.edu.
Abstract
AIMS: To assess the utility and tolerability of thiopurine-allopurinol co-therapy in inflammatory bowel disease (IBD) patients with intolerance to thiopurine monotherapy. METHODS: A retrospective observational study assessed cases of thiopurine intolerance then switched to thiopurine allopurinol co-therapy between 2011 and 2015 at two centres. Indications for switch, dosing and subsequent clinical outcomes (including thiopurine persistence) were recorded. RESULTS: Of 767 patients on thiopurines for IBD, 89 (12%) were switched to co-therapy for intolerance. 64/89 (72%) had Crohn's disease, 38 (43%) were males, median age at switch was 40y (range 17-78), median IBD duration 6y (0-29). Median follow-up was 1.9y (0-5). Reasons for switching to co-therapy included fatigue (37%), hepatotoxicity (23%), nausea (23%), arthralgia (10%), headache (12%) and hypersensitivity reaction (4%). Overall, 66 (74%) patients remained on co-therapy until most recent review and achieved a clinical response. High rates of overcoming intolerance (62-100%) occurred with co-therapy for all reasons above, although fatigue was less amenable to switching than non-fatigue indications (62% vs 91%, p = <0.001). Of 34 patients not escalated to biologics with endoscopic data, 15 were in remission (44%) at most recent review. CONCLUSION: Low-dose thiopurine combined with allopurinol appears safe and effective in overcoming intolerances to thiopurine monotherapy in many cases.
AIMS: To assess the utility and tolerability of thiopurine-allopurinol co-therapy in inflammatory bowel disease (IBD) patients with intolerance to thiopurine monotherapy. METHODS: A retrospective observational study assessed cases of thiopurine intolerance then switched to thiopurine allopurinol co-therapy between 2011 and 2015 at two centres. Indications for switch, dosing and subsequent clinical outcomes (including thiopurine persistence) were recorded. RESULTS: Of 767 patients on thiopurines for IBD, 89 (12%) were switched to co-therapy for intolerance. 64/89 (72%) had Crohn's disease, 38 (43%) were males, median age at switch was 40y (range 17-78), median IBD duration 6y (0-29). Median follow-up was 1.9y (0-5). Reasons for switching to co-therapy included fatigue (37%), hepatotoxicity (23%), nausea (23%), arthralgia (10%), headache (12%) and hypersensitivity reaction (4%). Overall, 66 (74%) patients remained on co-therapy until most recent review and achieved a clinical response. High rates of overcoming intolerance (62-100%) occurred with co-therapy for all reasons above, although fatigue was less amenable to switching than non-fatigue indications (62% vs 91%, p = <0.001). Of 34 patients not escalated to biologics with endoscopic data, 15 were in remission (44%) at most recent review. CONCLUSION: Low-dose thiopurine combined with allopurinol appears safe and effective in overcoming intolerances to thiopurine monotherapy in many cases.
Authors: Christopher Andrew Lamb; Nicholas A Kennedy; Tim Raine; Philip Anthony Hendy; Philip J Smith; Jimmy K Limdi; Bu'Hussain Hayee; Miranda C E Lomer; Gareth C Parkes; Christian Selinger; Kevin J Barrett; R Justin Davies; Cathy Bennett; Stuart Gittens; Malcolm G Dunlop; Omar Faiz; Aileen Fraser; Vikki Garrick; Paul D Johnston; Miles Parkes; Jeremy Sanderson; Helen Terry; Daniel R Gaya; Tariq H Iqbal; Stuart A Taylor; Melissa Smith; Matthew Brookes; Richard Hansen; A Barney Hawthorne Journal: Gut Date: 2019-09-27 Impact factor: 23.059
Authors: Elsa L S A van Liere; Ahmed B Bayoumy; Chris J J Mulder; Ben Warner; Bu Hayee; Bilal A Mateen; Jonathan D Nolan; Nanne K H de Boer; Simon H C Anderson; Azhar R Ansari Journal: Dig Dis Sci Date: 2021-11-02 Impact factor: 3.487
Authors: Vince B C Biemans; Edo Savelkoul; Ruben Y Gabriëls; Melek Simsek; Gerard Dijkstra; Marieke J Pierik; Rachel L West; Nanne K H de Boer; Frank Hoentjen Journal: Aliment Pharmacol Ther Date: 2020-04-27 Impact factor: 8.171