Tolerability and safety of mercaptopurine in azathioprine-intolerant patients with inflammatory bowel disease.
BACKGROUND
Azathioprine intolerance is a common clinical problem, requiring drug withdrawal in up to 30% of patients. The successful use of mercaptopurine is described, but data to support this strategy are needed.


OBJECTIVE
To assess the tolerability of mercaptopurine in inflammatory bowel disease patients previously intolerant of azathioprine, and identify predictive factors.


METHODS
Sixty-one azathioprine-intolerant patients (31 males, median age at diagnosis 32 years, 31 with Crohn's disease, 30 with ulcerative colitis) who had been treated with mercaptopurine were identified. Intolerances included nausea and vomiting, flu-like illness, neutropenia, hepatotoxicity and pancreatitis.


RESULTS
Mercaptopurine was tolerated by 59% (36 of 61) of azathioprine-intolerant patients (median dose 1.0 mg/kg), 61% (17 of 28) in patients with azathioprine-related nausea and vomiting, 61% (11 of 18) with flu-like illness, 33% (three of nine) with hepatotoxicity, 100% (one of one) with neutropenia, 100% (three of three) with rash and 0% (zero of one) with pancreatitis. Mercaptopurine intolerance was frequently for a different adverse event. Those intolerant of mercaptopurine were younger (28.4 years vs. 37.0 years; P = 0.014) and more frequently female (14/30 vs. 2/29, P = 0.027). Mercaptopurine tolerability was not affected by diagnosis, location, behaviour, surgery, smoking, family history or extra-intestinal manifestations.


CONCLUSIONS
Mercaptopurine may be tolerated in up to 60% of azathioprine-intolerant patients, and treatment should be considered, particularly if intolerance was due to nausea, vomiting, flu-like illness or rash.
Lees
C W
CW
GI Unit, University of Edinburgh, Edinburgh, UK. charlie.lees@ed.ac.uk
Maan
A K
AK
Hansoti
B
B
Satsangi
J
J
Arnott
I D R
ID
D000328:Adult; D017677:Age Distribution; D001379:Azathioprine / Q000009:adverse effects*; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000276:immunology; D003424:Crohn Disease / Q000188:drug therapy / Q000276:immunology; D004334:Drug Administration Schedule; D004342:Drug Hypersensitivity; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000276:immunology; D008297:Male; D015122:Mercaptopurine / Q000627:therapeutic use*; D008875:Middle Aged; D017678:Sex Distribution; D018709:Statistics, Nonparametric
D007166:Immunosuppressive Agents; D015122:Mercaptopurine; D001379:Azathioprine