Switching to a Second Thiopurine in Adult and Elderly Patients With Inflammatory Bowel Disease: A Nationwide Study From the ENEIDA Registry

BACKGROUND AND AIMS: Although commonly used in inflammatory bowel disease (IBD), thiopurines frequently cause intolerance and switching to a second thiopurine has only been reported in some small series. Ours aims in this study were to evaluate the safety of switching to a second thiopurine in a lar...

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Authors: Calafat, Margalida, Manosa, Miriam, Mesonero, Francisco, Guardiola, Jordi, Minguez, Miguel, Nos, Pilar, Vera, Isabel, Taxonera, Carlos, Iglesias, Eva, Ricart, Elena, Gisbert, Javier P, Calvet, Xavier, Garcia-Lopez, Santiago, Monfort, David, Perez Calle, Jose Lazaro, Riestra, Sabino, Gomollon, Fernando, Garcia-Planella, Esther, Bermejo, Fernando, Vicent, Hernandez, Martin-Arranz, Maria Dolores, Gutierrez, Ana, Torres, Paola, Canete, Fiorella, Domenech, Eugeni
Format: article
Status:Published version
Publication Date:2020
Country:España
Institution:INCLIVA
Repository:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
OAI Identifier:oai:incliva.fundanetsuite.com:p4491
Online Access:https://incliva.portalinvestigacion.com/publicaciones/4491
Access Level:Open access
Keyword:Thiopurine
inflammatory bowel disease
elderly
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spelling Switching to a Second Thiopurine in Adult and Elderly Patients With Inflammatory Bowel Disease: A Nationwide Study From the ENEIDA RegistryCalafat, MargalidaManosa, MiriamMesonero, FranciscoGuardiola, JordiMinguez, MiguelNos, PilarVera, IsabelTaxonera, CarlosIglesias, EvaRicart, ElenaGisbert, Javier PCalvet, XavierGarcia-Lopez, SantiagoMonfort, DavidPerez Calle, Jose LazaroRiestra, SabinoGomollon, FernandoGarcia-Planella, EstherBermejo, FernandoVicent, HernandezMartin-Arranz, Maria DoloresGutierrez, AnaTorres, PaolaCanete, FiorellaDomenech, EugeniThiopurineinflammatory bowel diseaseelderlyBACKGROUND AND AIMS: Although commonly used in inflammatory bowel disease (IBD), thiopurines frequently cause intolerance and switching to a second thiopurine has only been reported in some small series. Ours aims in this study were to evaluate the safety of switching to a second thiopurine in a large cohort and to assess the impact of age on tolerance.; METHODS: Adult IBD patients from the ENEIDA registry who were switched to a second thiopurine due to adverse events (excluding malignancies and infections) were identified. At the beginning of thiopurine treatment, patients were divided by age into two groups: 18-50 and over 60 years of age. The rate and concordance of adverse events between the first and second thiopurines, treatment intolerance and persistence with the second thiopurine were evaluated.; RESULTS: A total of 1,278 patients (13% over 60 years of age) were switched to a second thiopurine. At 12 months, the cumulative probability of switch intolerance was 43%, while persistence with treatment was 49%. Independent risk factors of switch intolerance were age over 60 years (OR 1.49; 95%CI 1.07-2.07; P=0.017), previous gastrointestinal toxicity (OR 1.4; 95%CI 1.11-1.78; P=0.005), previous acute pancreatitis (OR 6.78; 95%CI 2.55-18.05; P<0.001), and exposure to the first thiopurine <6 months (OR 1.59; 95%CI 1.14-2.23; P=0.007).; CONCLUSIONS: In a large series in clinical practice, switching to a second thiopurine proved to be a valid strategy. Tight monitoring of elderly IBD patients switching to a second thiopurine because of adverse events is recommended. © The Author(s) 2020. Published by Oxford University Press on behalf of European Crohns and Colitis Organisation. All rights reserved. For permissions, please email: journals.permissions@oup.com.OXFORD UNIV PRESS2020info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://incliva.portalinvestigacion.com/publicaciones/4491Journal of Crohns & ColitisISSN: 18739946ISSNe: 18764479reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVAinstname:INCLIVAInglésinfo:eu-repo/semantics/openAccessoai:incliva.fundanetsuite.com:p44912026-06-07T16:35:31Z
dc.title.none.fl_str_mv Switching to a Second Thiopurine in Adult and Elderly Patients With Inflammatory Bowel Disease: A Nationwide Study From the ENEIDA Registry
title Switching to a Second Thiopurine in Adult and Elderly Patients With Inflammatory Bowel Disease: A Nationwide Study From the ENEIDA Registry
spellingShingle Switching to a Second Thiopurine in Adult and Elderly Patients With Inflammatory Bowel Disease: A Nationwide Study From the ENEIDA Registry
Calafat, Margalida
Thiopurine
inflammatory bowel disease
elderly
title_short Switching to a Second Thiopurine in Adult and Elderly Patients With Inflammatory Bowel Disease: A Nationwide Study From the ENEIDA Registry
title_full Switching to a Second Thiopurine in Adult and Elderly Patients With Inflammatory Bowel Disease: A Nationwide Study From the ENEIDA Registry
title_fullStr Switching to a Second Thiopurine in Adult and Elderly Patients With Inflammatory Bowel Disease: A Nationwide Study From the ENEIDA Registry
title_full_unstemmed Switching to a Second Thiopurine in Adult and Elderly Patients With Inflammatory Bowel Disease: A Nationwide Study From the ENEIDA Registry
title_sort Switching to a Second Thiopurine in Adult and Elderly Patients With Inflammatory Bowel Disease: A Nationwide Study From the ENEIDA Registry
dc.creator.none.fl_str_mv Calafat, Margalida
Manosa, Miriam
Mesonero, Francisco
Guardiola, Jordi
Minguez, Miguel
Nos, Pilar
Vera, Isabel
Taxonera, Carlos
Iglesias, Eva
Ricart, Elena
Gisbert, Javier P
Calvet, Xavier
Garcia-Lopez, Santiago
Monfort, David
Perez Calle, Jose Lazaro
Riestra, Sabino
Gomollon, Fernando
Garcia-Planella, Esther
Bermejo, Fernando
Vicent, Hernandez
Martin-Arranz, Maria Dolores
Gutierrez, Ana
Torres, Paola
Canete, Fiorella
Domenech, Eugeni
author Calafat, Margalida
author_facet Calafat, Margalida
Manosa, Miriam
Mesonero, Francisco
Guardiola, Jordi
Minguez, Miguel
Nos, Pilar
Vera, Isabel
Taxonera, Carlos
Iglesias, Eva
Ricart, Elena
Gisbert, Javier P
Calvet, Xavier
Garcia-Lopez, Santiago
Monfort, David
Perez Calle, Jose Lazaro
Riestra, Sabino
Gomollon, Fernando
Garcia-Planella, Esther
Bermejo, Fernando
Vicent, Hernandez
Martin-Arranz, Maria Dolores
Gutierrez, Ana
Torres, Paola
Canete, Fiorella
Domenech, Eugeni
author_role author
author2 Manosa, Miriam
Mesonero, Francisco
Guardiola, Jordi
Minguez, Miguel
Nos, Pilar
Vera, Isabel
Taxonera, Carlos
Iglesias, Eva
Ricart, Elena
Gisbert, Javier P
Calvet, Xavier
Garcia-Lopez, Santiago
Monfort, David
Perez Calle, Jose Lazaro
Riestra, Sabino
Gomollon, Fernando
Garcia-Planella, Esther
Bermejo, Fernando
Vicent, Hernandez
Martin-Arranz, Maria Dolores
Gutierrez, Ana
Torres, Paola
Canete, Fiorella
Domenech, Eugeni
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Thiopurine
inflammatory bowel disease
elderly
topic Thiopurine
inflammatory bowel disease
elderly
description BACKGROUND AND AIMS: Although commonly used in inflammatory bowel disease (IBD), thiopurines frequently cause intolerance and switching to a second thiopurine has only been reported in some small series. Ours aims in this study were to evaluate the safety of switching to a second thiopurine in a large cohort and to assess the impact of age on tolerance.; METHODS: Adult IBD patients from the ENEIDA registry who were switched to a second thiopurine due to adverse events (excluding malignancies and infections) were identified. At the beginning of thiopurine treatment, patients were divided by age into two groups: 18-50 and over 60 years of age. The rate and concordance of adverse events between the first and second thiopurines, treatment intolerance and persistence with the second thiopurine were evaluated.; RESULTS: A total of 1,278 patients (13% over 60 years of age) were switched to a second thiopurine. At 12 months, the cumulative probability of switch intolerance was 43%, while persistence with treatment was 49%. Independent risk factors of switch intolerance were age over 60 years (OR 1.49; 95%CI 1.07-2.07; P=0.017), previous gastrointestinal toxicity (OR 1.4; 95%CI 1.11-1.78; P=0.005), previous acute pancreatitis (OR 6.78; 95%CI 2.55-18.05; P<0.001), and exposure to the first thiopurine <6 months (OR 1.59; 95%CI 1.14-2.23; P=0.007).; CONCLUSIONS: In a large series in clinical practice, switching to a second thiopurine proved to be a valid strategy. Tight monitoring of elderly IBD patients switching to a second thiopurine because of adverse events is recommended. © The Author(s) 2020. Published by Oxford University Press on behalf of European Crohns and Colitis Organisation. All rights reserved. For permissions, please email: journals.permissions@oup.com.
publishDate 2020
dc.date.none.fl_str_mv 2020
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://incliva.portalinvestigacion.com/publicaciones/4491
url https://incliva.portalinvestigacion.com/publicaciones/4491
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv OXFORD UNIV PRESS
publisher.none.fl_str_mv OXFORD UNIV PRESS
dc.source.none.fl_str_mv Journal of Crohns & Colitis
ISSN: 18739946
ISSNe: 18764479
reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
instname:INCLIVA
instname_str INCLIVA
reponame_str r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
collection r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,812455

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