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World J Gastroenterol. Jul 21, 2008; 14(27): 4342-4346
Published online Jul 21, 2008. doi: 10.3748/wjg.14.4342
Efficacy of 6-mercaptopurine treatment after azathioprine hypersensitivity in inflammatory bowel disease
Ferenc Nagy, Tamás Molnár, Zoltán Szepes, Klaudia Farkas, Tibor Nyári, János Lonovics
Ferenc Nagy, Tamás Molnár, Zoltán Szepes, Klaudia Farkas, János Lonovics, First Department of Medicine, University of Szeged, Faculty of Medicine, Szeged, Hungary
Tibor Nyári, Institute of Medical Informatics, University of Szeged, Faculty of Medicine, Szeged, Hungary
Correspondence to: Ferenc Nagy, MD, PhD, First Department of Medicine, Faculty of Medicine, University of Szeged, Korányi fasor 8, H-6701, Szeged, POB: 427, Hungary. agyferi@in1st.szote.u-szeged.hu
Telephone: +36-62-545185
Fax: +36-62-545185
Received: June 28, 2007
Revised: April 6, 2008
Accepted: April 13, 2008
Published online: July 21, 2008
Abstract

AIM: To investigate the efficacy of 6-mercaptopurine (6-MP) in cases of azathioprine (AZA) hypersensitivity in patients with inflammatory bowel disease.

METHODS: Twenty nine previously confirmed Crohn’s disease (CD) (n = 14) and ulcerative colitis (UC) (n = 15) patients with a known previous (AZA) hypersensitivity reaction were studied prospectively. The 6-MP doses were gradually increased from 0.5 up to 1.0-1.5 mg/kg per day. Clinical activity indices (CDAI/CAI), laboratory variables and daily doses of oral 5-ASA, corticosteroids, and 6-MP were assessed before and in the first, sixth and twelfth months of treatment.

RESULTS: In 9 patients, 6-MP was withdrawn in the first 2 wk due to an early hypersensitivity reaction. Medication was ineffective within 6 mo in 6 CD patients, and myelotoxic reaction was observed in two. Data were evaluated at the end of the sixth month in 12 (8 UC, 4 CD) patients, and after the first year in 9 (6 UC, 3 CD) patients. CDAI decreased transiently at the end of the sixth month, but no significant changes were observed in the CDAI or the CAI values at the end of the year. Leukocyte counts (P = 0.01), CRP (P = 0.02), and serum iron (P = 0.05) values indicated decreased inflammatory reactions, especially in the UC patients at the end of the year, making the possibility to taper oral steroid doses.

CONCLUSION: About one-third of the previously AZA-intolerant patients showed adverse effects on taking 6MP. In our series, 20 patients tolerated 6MP, but it was ineffective in 8 CD cases, and valuable mainly in ulcerative colitis patients.

Keywords: Inflammatory bowel disease; Azathioprine; 6-mercaptopurine; Side effects; Efficacy