title: How are thiopurines used and monitored by Swedish gastroenterologists when treating patients with inflammatory bowel disease?
abstract: OBJECTIVE
  To perform a survey of thiopurine treatment in inflammatory bowel disease (IBD) among Swedish gastroenterologists.
  
  
  METHODS
  A web-based questionnaire consisting of 25 multiple-choice questions was sent to 322 gastroenterologists in adult practice.
  
  
  RESULTS
  A total of 132 questionnaires were received giving a response rate of 41%. Thiopurines were used by all 122 gastroenterologists in IBD practice and azathioprine was the first-choice thiopurine among 118 (97%) of them. Almost all gastroenterologists (97%) used weight-based dosing that was gradually escalated. The vast majority (89%) considered that efficacy should be evaluated within 6 months of therapy, while opinions regarding the optimal duration of therapy varied considerably. It was seen that 74% switched thiopurine in case of intolerance to the first-line substance. Thiopurine S-methyltransferase (TPMT) determinations were performed by 74% of the gastroenterologists and 67% used metabolite measurements. TPMT analyzers were more likely to measure metabolites (74 vs. 43%, p = 0.002). A quarter of the respondents were familiar with unconventional immunomodulation (co-administration of allopurinol, 6-thioguanine, mycophenolate mofetil or tacrolimus) and these respondents were also more likely to measure metabolites (79 vs. 52%; p = 0.002).
  
  
  CONCLUSIONS
  Thiopurines are well established in the treatment of IBD among Swedish gastroenterologists. New and evolving knowledge about thiopurine therapy in IBD has been adapted to a large extent. Whether this change in clinical practice will have an impact on treatment outcomes has yet to be proven.
authors.affiliation: Gastroenterology Clinic, Skåne University Hospital, Lund, Sweden. ulf.hindorf@skane.se
authors.forename: Ulf
authors.initials: U
authors.lastname: Hindorf
authors.forename: Philip
authors.initials: P
authors.lastname: Andersson
mesh_terms: D000493:Allopurinol / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000963:Antimetabolites / Q000627:therapeutic use; D001379:Azathioprine / Q000378:metabolism / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005762:Gastroenterology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000201:enzymology; D008297:Male; D008780:Methyltransferases / Q000097:blood; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D013548:Sweden; D016559:Tacrolimus / Q000627:therapeutic use; D013866:Thioguanine / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000911:Antibodies, Monoclonal; D000963:Antimetabolites; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D000493:Allopurinol; D008780:Methyltransferases; C022745:thiopurine methyltransferase; D013866:Thioguanine; D009173:Mycophenolic Acid; D001379:Azathioprine; D016559:Tacrolimus