title: How thiopurines are used for the treatment of inflammatory bowel diseases: an Italian survey.
abstract: BACKGROUND
  The ideal manner of thiopurine use in inflammatory bowel disease has not been defined. We aimed at investigating the attitudes of Italian gastroenterologists on thiopurine use.
  
  
  METHODS
  A web-based survey was performed among 295 gastroenterologists.
  
  
  RESULTS
  Overall, 70 surveys were completed. At baseline, thiopurine methyltransferase genotype and phenotype were not assessed by 87.1% and 97.1% of respondents, respectively. At treatment onset, 17.1% adopted full weight-calculated dose while 80.0% preferred escalating the dose. During treatment, 87.1% and 64.3% reduced the dose for myelo- and liver toxicity, respectively; 48.6% for increased pancreatic enzymes, 17.1% for fever, and 5.7% for arthralgia. A systematic shift from one thiopurine to the other was reported by 4.3% of respondents in case of failure, and by 5.7% for adverse effects. Forty-four gastroenterologists (62.9%) stopped thiopurine treatment after 5-7 years.
  
  
  CONCLUSIONS
  Several discrepancies regarding the use of thiopurines in clinical practice were found, deviating from available guidelines. A more standardised attitude is needed in clinical practice.
authors.affiliation: Azienda Ospedaliera Guido Salvini, Ospedale di Rho, Rho, Italy. Electronic address: saibo@tiscali.it.
authors.forename: Simone
authors.initials: S
authors.lastname: Saibeni
authors.affiliation: Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Kohn
authors.affiliation: Ospedale San Giuseppe, Milan, Italy.
authors.forename: Gianmichele
authors.initials: G
authors.lastname: Meucci
authors.affiliation: Azienda Ospedaliera San Filippo Neri, Rome, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Papi
mesh_terms: D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D003424:Crohn Disease / Q000188:drug therapy*; D005762:Gastroenterology / Q000592:standards; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007558:Italy; D015122:Mercaptopurine / Q000627:therapeutic use*; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*
chemical_list: D007166:Immunosuppressive Agents; D015122:Mercaptopurine; D001379:Azathioprine
keywords: Crohn's disease; Inflammatory bowel disease; Thiopurines; Ulcerative colitis