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A comparative analysis of tioguanine versus low‐dose thiopurines combined with allopurinol in inflammatory bowel disease patients
Author(s) -
Biemans Vince B. C.,
Savelkoul Edo,
Gabriëls Ruben Y.,
Simsek Melek,
Dijkstra Gerard,
Pierik Marieke J.,
West Rachel L.,
Boer Nanne K.H.,
Hoentjen Frank
Publication year - 2020
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.15730
Subject(s) - medicine , adverse effect , inflammatory bowel disease , thiopurine methyltransferase , discontinuation , concomitant , crohn's disease , propensity score matching , odds ratio , allopurinol , ulcerative colitis , gastroenterology , surgery , disease
Summary Background Both tioguanine and low‐dose thiopurines combined with allopurinol (LDTA) can be considered for the treatment of inflammatory bowel disease (IBD) when conventional thiopurines fail due to adverse events. Aim To compare the safety of tioguanine and LDTA in IBD patients. Methods Inflammatory bowel disease patients who failed conventional thiopurines due to adverse events and initiated LDTA in standard care were identified in the prospective ICC Registry. IBD patients who failed conventional thiopurines due to adverse events and initiated tioguanine were enrolled in three university hospitals. Patients on concomitant biologicals were excluded. The primary outcome was discontinuation of therapy due to adverse events. Secondary outcomes included: safety outcomes and surgery‐, biological‐ and corticosteroid‐free clinical remission (physician global assessment = 0) after 104 weeks. Both multiple logistic regression and propensity score matching were used to correct for confounders. Results In total, 182 IBD patients treated with tioguanine (n = 94) or LDTA (n = 88) were included with a median follow‐up of 104 weeks (IQR 91‐104). Of these, 19% (tioguanine: 20%, LDTA: 18%) of patients discontinued therapy due to adverse events. After adjusting for confounders, there were no differences in terms of discontinuation rate due to adverse events (OR 0.50, 95% CI 0.15‐1.68, P = 0.26), adverse events (OR 0.89, 95% CI 0.44‐1.81, P = 0.75), infections (OR 1.05, 95% CI 0.40‐2.73, P = 0.93), hospitalisations (OR 2.00, 95% CI 0.64‐6.23, P = 0.23) or clinical remission (OR 0.74, 95%CI 0.33‐1.68, P = 0.48). All results are comparable with the propensity score matched cohort. Conclusion Nineteen percent of IBD patients with prior failure to conventional thiopurines due to adverse events discontinued therapy with tioguanine or LDTA due to adverse events. Either therapy may be considered before escalating to biological therapy.