title: 6-mercaptopurine in patients with inflammatory bowel disease and previous digestive intolerance of azathioprine.
abstract: OBJECTIVE
  Azathioprine and 6-mercaptopurine are useful therapies in inflammatory bowel diseases. Despite their efficacy, their use is limited owing to treatment intolerance or toxicity in 10-15% of patients. It has been suggested that both drugs could be interchangeable.
  
  
  METHODS
  All patients treated with 6-mercaptopurine because of previous digestive intolerance of azathioprine in four Spanish hospitals were reviewed. Tolerance of 6-mercaptopurine therapy was assessed.
  
  
  RESULTS
  Fifteen patients (11 Crohn's disease, 4 ulcerative colitis) were included. Immunosuppressant therapy was prescribed for steroid-dependent disease in 13 cases, and for perianal disease in 2. Main symptoms of digestive intolerance were epigastric pain, nausea and vomiting, which developed within the first weeks of treatment. Acute pancreatitis was ruled out in all the cases. Five patients commenced 6-mercaptopurine immediately after azathioprine discontinuation and 7 patients within the first month. Eleven patients (73.3%) tolerated 6-mercaptopurine and reached the therapeutic goals; only two patients had to discontinue 6-mercaptopurine because of adverse effects.
  
  
  CONCLUSIONS
  Treatment with 6-mercaptopurine is a safe alternative in patients with inflammatory bowel diseases and previous digestive intolerance of azathioprine.
authors.affiliation: Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. domenech@ns.hugtip.scs.es
authors.forename: Eugeni
authors.initials: E
authors.lastname: Domènech
authors.forename: Pilar
authors.initials: P
authors.lastname: Nos
authors.forename: Michel
authors.initials: M
authors.lastname: Papo
authors.forename: Antonio
authors.initials: A
authors.lastname: López-San Román
authors.forename: Esther
authors.initials: E
authors.lastname: Garcia-Planella
authors.forename: Miquel A
authors.initials: MA
authors.lastname: Gassull
mesh_terms: D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000188:drug therapy; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D020714:Maximum Tolerated Dose; D015122:Mercaptopurine / Q000627:therapeutic use*; D008875:Middle Aged; D012189:Retrospective Studies; D013030:Spain; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D015122:Mercaptopurine; D001379:Azathioprine