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Adherence to thiopurine treatment in out‐patients with Crohn’s disease
Author(s) -
BOKEMEYER B.,
TEML A.,
ROGGEL C.,
HARTMANN P.,
FISCHER C.,
SCHAEFFELER E.,
SCHWAB M.
Publication year - 2007
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/j.1365-2036.2007.03365.x
Subject(s) - thiopurine methyltransferase , medicine , azathioprine , concordance , mercaptopurine , crohn's disease , gastroenterology , therapeutic drug monitoring , metabolite , pharmacotherapy , disease , pharmacokinetics
Summary Background High frequency of incomplete or non‐response to azathioprine (AZA) and/or mercaptopurine (MP) limit their use in Crohn’s disease (CD). Non‐adherence is considered to be of relevance for ineffectiveness. Aim To assess adherence to thiopurines in CD out‐patients treated in a single gastroenterology practice. Methods Patients were eligible for inclusion if they received AZA/MP for at least 3 months. After follow‐up of 3 months, adherence to AZA/MP was assessed by quantitation of relevant thiopurine metabolite levels in red blood cells as well as by patients’ self‐report using standardized questionnaire. Results Sixty‐five patients were prospectively included. Six patients (9.2%) had metabolite profiles indicative of non‐adherence. Self‐assessed questionnaire revealed non‐adherence in four of 56 patients (7.1%). Therapeutic drug monitoring (TDM) and self‐assessment as two independent methods had a concordance rate of 75%. Metabolite levels and self‐assessed adherence were not significantly different between patients in remission compared with those with active disease. Conclusions Out‐patients with CD treated in a single gastroenterology practice had a satisfactory adherence (>90%) to thiopurine therapy. Different measures of adherence (TDM and self‐report) applied to the same patient suggest comparable levels. TDM appears to be a reliable tool to assess adherence to thiopurines in clinical practice.