Switching to a Second Thiopurine in Adult and Elderly Patients With Inflammatory Bowel Disease: A Nationwide Study From the ENEIDA Registry
Por:
Calafat, M, Manosa, M, Mesonero, F, Guardiola, J, Minguez, M, Nos, P, Vera, I, Taxonera, C, Iglesias, E, Ricart, E, Gisbert, JP, Calvet, X, Garcia-Lopez, S, Monfort, D, Calle, JLP, Riestra, S, Gomollon, F, Garcia-Planella, E, Bermejo, F, Hernandez, V, Martin-Arranz, MD, Gutierrez, A, Torres, P, Canete, F, Domenech, E
Publicada:
1 sep 2020
Resumen:
Background and Aims: Although commonly used in inflammatory bowel disease [IBD], thiopurines frequently cause intolerance, and switching to a second thiopurine has only been reported in some small series. Ours aims in this study were to evaluate the safety of switching to a second thiopurine in a large cohort, and to assess the impact of age on tolerance.
Methods: Adult IBD patients from the ENEIDA registry, who were switched to a second thiopurine due to adverse events [excluding malignancies and infections], were identified. At the beginning of thiopurine treatment, patients were divided by age into two groups: 18-50 and over 60 years of age. The rate and concordance of adverse events between the first and second thiopurines, treatment intolerance, and persistence with the second thiopurine were evaluated.
Results: A total of 1278 patients [13% over 60 years of age] were switched to a second thiopurine. At 12 months, the cumulative probability of switch intolerance was 43%, and persistence with treatment was 49%. Independent risk factors of switch intolerance were age over 60 years (odds ratio [OR] 1.49; 95% confidence interval [CI] 1.07-2.07; p = 0.017) , previous gastrointestinal toxicity [OR 1.4; 95% CI 1.11-1.78; p = 0.005], previous acute pancreatitis [OR 6.78; 95% CI 2.55-18.05; p<0.001], and exposure to the first thiopurine <6 months [OR 1.59; 95% CI 1.14-2.23; p = 0.007].
Conclusions: In a large series in clinical practice, switching to a second thiopurine proved to be a valid strategy. Tight monitoring of elderly IBD patients switching to a second thiopurine because of adverse events is recommended.
Filiaciones:
Calafat, M:
Hosp Badalona Germans Trias & Pujol, Badalona, Spain
Univ Autonoma Barcelona, Dept Med, Barcelona, Spain
Manosa, M:
Hosp Badalona Germans Trias & Pujol, Badalona, Spain
Univ Autonoma Barcelona, Dept Med, Barcelona, Spain
CIIBEREHD, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain
Mesonero, F:
Hosp Univ Ramon y Cajal, Madrid, Spain
Guardiola, J:
Hosp Llobregat Univ Barcelona, IDIBELL, Hosp Univ Bellvitge, Barcelona, Spain
Minguez, M:
Univ Valencia, Hosp Clin Valencia, Valencia, Spain
Nos, P:
CIIBEREHD, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain
Hosp Univ & Politecn La Fe, Valencia, Spain
Vera, I:
Hosp Univ Puerta Hierro, Majadahonda, Spain
Taxonera, C:
Hosp Clin San Carlos, Madrid, Spain
Iglesias, E:
Hosp Reina Sofia, Cordoba, Spain
Ricart, E:
CIIBEREHD, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain
IDIBAPS, Hosp Clin, Barcelona, Spain
Gisbert, JP:
CIIBEREHD, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain
Univ Autonoma Madrid, Inst Invest Sanitaria Princesa IIS IP, Hosp Univ La Princesa, Madrid, Spain
Calvet, X:
CIIBEREHD, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain
Hosp Parc Tauli, Sabadell, Spain
Garcia-Lopez, S:
Hosp Univ Miguel Servet, Zaragoza, Spain
Monfort, D:
Consorci Sanitari Terrassa, Terrassa, Spain
Calle, JLP:
Hosp Univ Fdn Alcorcon, Alcorcon, Spain
Riestra, S:
Hosp Univ Cent Asturias, Inst Invest Sanitaria Principado Asturias ISPAI, Oviedo, Spain
Gomollon, F:
CIIBEREHD, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain
Hosp Clin Lozano Blesa, IIS Aragon, Zaragoza, Spain
Garcia-Planella, E:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Bermejo, F:
Inst Invest Sanitaria Hosp La Paz IdiPaz, Madrid, Spain
Hosp Univ Fuenlabrada Fuenlabrada, Fuenlabrada, Spain
Hernandez, V:
SERGAS UVIGO, Gastrointestinal Dis Res Grp, Galicia Sur Hlth Res Inst IIS Galicia Suit, Pontevedra, Spain
Complexo Hosp Univ Vigo, Vigo, Spain
Martin-Arranz, MD:
Hosp Univ La Paz, Madrid, Spain
Gutierrez, A:
Hosp Gen Univ Alicante, Alicante, Spain
CIIBEREHD, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain
Torres, P:
Hosp Badalona Germans Trias & Pujol, Badalona, Spain
Canete, F:
CIIBEREHD, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain
Univ Autonoma Barcelona, Dept Med, Barcelona, Spain
Hosp Badalona Germans Trias & Pujol, Badalona, Spain
Domenech, E:
CIIBEREHD, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain
Univ Autonoma Barcelona, Dept Med, Barcelona, Spain
Hosp Badalona Germans Trias & Pujol, Badalona, Spain
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