Feasibility of Reduced Clinical Monitoring in Patients with Inflammatory Bowel Disease Treated with Thiopurine Therapy

Background Outpatient visits and laboratory assessments are routinely scheduled every 3 to 4 months in thiopurine-treated patients with inflammatory bowel disease (IBD) to timely detect thiopurine-related adverse events (AEs). AEs that require therapy adjustment beyond 12 months of treatment are rare. Aim and Methods This single-center prospective cohort study evaluated the safety of a reduced 6-monthly monitoring strategy in steroid-free patients with quiescent IBD on stable dose of azathioprine, mercaptopurine, or thioguanine monotherapy. The primary outcome was thiopurine-related AEs requiring therapy adjustments during a follow-up period of 24 months. Secondary outcomes included all AEs including laboratory toxicity, disease flares until 12 months, and the net monetary benefit from this strategy concerning IBD-related health care use. Results We enrolled 85 patients with IBD (median age 42 years, 61% Crohn’s disease, 62% female), with a median disease duration of 12.5 years and median thiopurine treatment duration of 6.7 years. During follow-up, 3 patients (4%) ceased thiopurines due to AEs: recurrent infections, non-melanoma skin cancer, and gastrointestinal complaints (nausea, vomiting). At 12 months, 25 laboratory toxicities were observed (including 13% myelotoxicity, 17% hepatotoxicity); none required therapy adjustments and all were transient. A reduced monitoring strategy had a net benefit of €136 per patient. Conclusion Three patients (4%) ceased thiopurine therapy due to thiopurine-related AEs, while no laboratory toxicity required therapy adjustments. Monitoring frequency of every 6 months seems feasible in patients with stable IBD on long-term (median duration > 6 years) maintenance thiopurine therapy and may contribute to reduced patient-burden and health care costs..

Medienart:	E-Artikel

Erscheinungsjahr:	2023
Erschienen:	2023

Enthalten in:	Zur Gesamtaufnahme - volume:68
Enthalten in:	Digestive diseases and sciences - 68(2023), 7 vom: 02. Mai, Seite 2936-2945

Sprache:	Englisch

Beteiligte Personen:	Jansen, Fenna M. [VerfasserIn] Smits, Lisa J. T. [VerfasserIn] Thomas, Pepijn W. A. [VerfasserIn] de Jong, Dirk J. [VerfasserIn] Kreijne, Joany E. [VerfasserIn] van Dop, Willemijn A. [VerfasserIn] den Broeder, Nathan [VerfasserIn] Hoentjen, Frank [VerfasserIn]

Links:	Volltext [kostenfrei]

Themen:	Adverse events Inflammatory bowel disease Monitoring Safety Thiopurines

Anmerkungen:	© The Author(s) 2023

doi:	10.1007/s10620-023-07950-0

funding:
Förderinstitution / Projekttitel:

PPN (Katalog-ID):	SPR052036669