Clinical experience of optimising thiopurine use through metabolite measurement in inflammatory bowel disease
Copyright © 2018 Elsevier España, S.L.U. All rights reserved..
INTRODUCTION: Thiopurine therapy can be optimised by determining the concentration of the drug's metabolites.
PATIENTS AND METHODS: Retrospective analysis on a prospective database of 31 patients with inflammatory bowel disease who failed therapy with thiopurines. Thiopurine metabolites (6-thioguanine, 6-TGN and 6-methylmercaptopurine, 6-MMP) were measured by high-performance liquid chromatography (Laboratorios Cerba, Barcelona) and treatment was duly adjusted in accordance with the results. Clinical response was reassessed after six months.
RESULT: Despite the appropriate theoretical dose of thiopurines being administered, the dose was insufficient in 45.6% of patients (nonadherence to treatment suspected in 6.45%) and 16.2% received an excessive dose or the drug was metabolised by other metabolic pathways. After treatment was optimised based on metabolite levels, only 25.8% (8/31) were prescribed a biological agent, while 74.2% of cases (23/31) were managed through dose optimisation alone.
DISCUSSION: Monitoring thiopurine metabolite levels may help clinicians to assess non-responsive patients before adding or switching to another drug (generally a biological agent), thereby avoiding any additional costs or potential toxicity. This strategy may also help to identify patients receiving an insufficient dose and those with an alternative metabolic pathway, who could be candidates for low-dose AZA with allopurinol, as well as patients who are suspected of being non-adherent. In three out of four patients, switching to a biological agent can be avoided.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2018 |
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| Erschienen: |
2018 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:41 |
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| Enthalten in: |
Gastroenterologia y hepatologia - 41(2018), 10 vom: 20. Dez., Seite 629-635 |
| Sprache: |
Englisch |
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| Weiterer Titel: |
Experiencia en práctica clínica de optimización de tiopurinas mediante determinación de sus metabolitos en la enfermedad inflamatoria intestinal |
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| Beteiligte Personen: |
Sánchez Rodríguez, Eugenia [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 05.06.2019 Date Revised 05.06.2019 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.gastrohep.2018.06.013 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM287468364 |
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| 245 | 1 | 0 | |a Clinical experience of optimising thiopurine use through metabolite measurement in inflammatory bowel disease |
| 246 | 3 | 3 | |a Experiencia en práctica clínica de optimización de tiopurinas mediante determinación de sus metabolitos en la enfermedad inflamatoria intestinal |
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| 520 | |a Copyright © 2018 Elsevier España, S.L.U. All rights reserved. | ||
| 520 | |a INTRODUCTION: Thiopurine therapy can be optimised by determining the concentration of the drug's metabolites | ||
| 520 | |a PATIENTS AND METHODS: Retrospective analysis on a prospective database of 31 patients with inflammatory bowel disease who failed therapy with thiopurines. Thiopurine metabolites (6-thioguanine, 6-TGN and 6-methylmercaptopurine, 6-MMP) were measured by high-performance liquid chromatography (Laboratorios Cerba, Barcelona) and treatment was duly adjusted in accordance with the results. Clinical response was reassessed after six months | ||
| 520 | |a RESULT: Despite the appropriate theoretical dose of thiopurines being administered, the dose was insufficient in 45.6% of patients (nonadherence to treatment suspected in 6.45%) and 16.2% received an excessive dose or the drug was metabolised by other metabolic pathways. After treatment was optimised based on metabolite levels, only 25.8% (8/31) were prescribed a biological agent, while 74.2% of cases (23/31) were managed through dose optimisation alone | ||
| 520 | |a DISCUSSION: Monitoring thiopurine metabolite levels may help clinicians to assess non-responsive patients before adding or switching to another drug (generally a biological agent), thereby avoiding any additional costs or potential toxicity. This strategy may also help to identify patients receiving an insufficient dose and those with an alternative metabolic pathway, who could be candidates for low-dose AZA with allopurinol, as well as patients who are suspected of being non-adherent. In three out of four patients, switching to a biological agent can be avoided | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Enfermedad inflamatoria intestinal | |
| 650 | 4 | |a Inflammatory bowel disease | |
| 650 | 4 | |a Metabolitos de tiopurinas | |
| 650 | 4 | |a Thiopurine metabolites | |
| 650 | 4 | |a Thiopurines | |
| 650 | 4 | |a Tiopurinas | |
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| 650 | 7 | |a Azathioprine |2 NLM | |
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| 700 | 1 | |a Mesonero Gismero, Francisco |e verfasserin |4 aut | |
| 700 | 1 | |a Albillos, Agustín |e verfasserin |4 aut | |
| 700 | 1 | |a Lopez-Sanroman, Antonio |e verfasserin |4 aut | |
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