Low-dose thiopurine with allopurinol co-therapy overcomes thiopurine intolerance and allows thiopurine continuation in inflammatory bowel disease

Abhinav Vasudevan, Lauren Beswick, Antony B. Friedman, Alicia Moltzen, James Haridy, Ajay Raghunath, Miles Sparrow, Daniel van Langenberg

Research output: Contribution to journalArticleResearchpeer-review

11 Citations (Scopus)

Abstract

Aims: To assess the utility and tolerability of thiopurine-allopurinol co-therapy in inflammatory bowel disease (IBD) patients with intolerance to thiopurine monotherapy. Methods: A retrospective observational study assessed cases of thiopurine intolerance then switched to thiopurine allopurinol co-therapy between 2011 and 2015 at two centres. Indications for switch, dosing and subsequent clinical outcomes (including thiopurine persistence) were recorded. Results: Of 767 patients on thiopurines for IBD, 89 (12%) were switched to co-therapy for intolerance. 64/89 (72%) had Crohn's disease, 38 (43%) were males, median age at switch was 40y (range 17–78), median IBD duration 6y (0–29). Median follow-up was 1.9y (0–5). Reasons for switching to co-therapy included fatigue (37%), hepatotoxicity (23%), nausea (23%), arthralgia (10%), headache (12%) and hypersensitivity reaction (4%). Overall, 66 (74%) patients remained on co-therapy until most recent review and achieved a clinical response. High rates of overcoming intolerance (62–100%) occurred with co-therapy for all reasons above, although fatigue was less amenable to switching than non-fatigue indications (62% vs 91%, p = <0.001). Of 34 patients not escalated to biologics with endoscopic data, 15 were in remission (44%) at most recent review. Conclusion: Low-dose thiopurine combined with allopurinol appears safe and effective in overcoming intolerances to thiopurine monotherapy in many cases.

Original languageEnglish
Pages (from-to)682-688
Number of pages7
JournalDigestive and Liver Disease
Volume50
Issue number7
DOIs
Publication statusPublished - Jul 2018

Keywords

  • Azathioprine
  • Colitis
  • Crohn's
  • Mercaptopurine
  • Tolerability

Cite this