Thiopurine undertreatment among inflammatory bowel disease patients referred for anti-TNF therapy
Veronika Suchá1, Barbora Kadlečková2, Beáta Repáková3, Ľubica Krajčíová4, Ľubomír Jurgoš1, Soňa Kiňová5, Zuzana Zelinková2
1 Gastroenterologická ambulancia, Gastrocentrum Bajkalská s. r. o., Bratislava
2 Gastroenterologické oddelenie a oddelenie digestívnej endoskopie, Interná Klinika SZU, Univerzitná Nemocnica – Nemocnica sv. Michala, Bratislava
3 IBD centrum, Assiduo, Bratislava, Slovenská republika
4 Ústav lekárskej biológie, genetiky a klinickej genetiky, LF UK a UN Bratislava, Slovenská republika
5 I. interná klinika LF UK a UN Bratislava, Slovenská republika
Thiopurines are effective in maintaining remission in inflammatory bowel disease (IBD) patients. Their effect is dose-dependent, and the optimal daily dose of azathioprine (AZA) is 2–2.5 mg/kg. Inadequate dosing may result in lack of efficacy and ensuing premature referral for biological therapy. Aim: The aims were to assess the rate of deviation from the normal thiopurine dose among IBD patients referred for biological therapy and to analyze the reasons for this deviation. Patients and Methods: All the IBD patients referred for anti-TNF therapy in one referral center by November 2014 were included. The dose of AZA at the time of indication for step-up to anti-TNF was noted, as well as the reasons for the use of a reduced dose of AZA, which was defined as a dose lower than 2 mg/kg. Results: In total, 176 IBD patients were included. The mean age was 37 years (range 18–76 years), 92 (52%) were men, 120 (68%) had Crohn‘s disease, 54 (31%) had ulcerative colitis, and two (1%) were IBD unclassified. Twenty-eight patients (16%) were receiving an unreduced dose of AZA; 93 (53%) patients had not used AZA previously (8 patients; 5%) or were using a low dose of AZA (85 patients; 48%) without documented reasons; 55 patients (32%) had discontinued AZA (38 patients; 22%) or undergone a dose reduction (17 patients; 10%) of AZA because of adverse events. Conclusion: In a real life clinical practice a substantial proportion of IBD patients referred for anti-TNF therapy are using low dose AZA with only a minority for well documented reasons of biologically-determined intolerance.
Keywordstreatment, inflammatory bowel disease, thiopurines
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