Long-term safety and efficacy of low-dose azathioprine and allopurinol cotherapy in inflammatory bowel disease: a large observational study

Pavlidis, Polychronis, Stamoulos, Panagiotis, Abdulrehman, Answar, Kerr, Patrick, Bull, Claire, Duley, John and Ansari, Azhar (2016) Long-term safety and efficacy of low-dose azathioprine and allopurinol cotherapy in inflammatory bowel disease: a large observational study. Inflammatory Bowel Diseases, 22 7: 1639-1646. doi:10.1097/MIB.0000000000000827


Author Pavlidis, Polychronis
Stamoulos, Panagiotis
Abdulrehman, Answar
Kerr, Patrick
Bull, Claire
Duley, John
Ansari, Azhar
Title Long-term safety and efficacy of low-dose azathioprine and allopurinol cotherapy in inflammatory bowel disease: a large observational study
Journal name Inflammatory Bowel Diseases   Check publisher's open access policy
ISSN 1078-0998
1536-4844
Publication date 2016-07
Sub-type Article (original research)
DOI 10.1097/MIB.0000000000000827
Open Access Status Not Open Access
Volume 22
Issue 7
Start page 1639
End page 1646
Total pages 8
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams & Wilkins
Collection year 2017
Language eng
Formatted abstract
Background: Low-dose azathioprine with allopurinol (LDAA) has been proposed as a potent therapy in inflammatory bowel disease (IBD) with the benefit of overcoming side effects regularly associated with thiopurine monotherapy and poor responses. Concerns regarding safety remain, while a layer of complexity has been added by the trend toward treatment directed by red cell thioguanine nucleotide (TGN) profiling. We report on the clinical efficacy and safety of LDAA use in IBD undirected by metabolite profiling.
Methods: Observational study of clinical practice from a single IBD center. Patient outcomes were defined clinically based on established activity scores and corticosteroid withdrawal. Red cell TGN was monitored only for suspected nonadherence.
Results: Overall, 113/164 (69%) patients with Crohn's disease and 83/136 (61%) patients with ulcerative/unclassified colitis had a clinical response by the end of follow-up (median 19 months), while 85 (52%) patients with Crohn's disease and 74 (54%) patients with ulcerative/unclassified colitis were in clinical remission. Clinical response was seen in 45/57 (79%) patients with Crohn's disease and 34/53 (64%) patients with ulcerative/unclassified colitis who were thiopurine naive, had active IBD, and received LDAA as the first line immunomodulator, while in 35 (61%) and 28 (53%), respectively, remission was achieved. LDAA was stopped in 20/300 (7%) patients because of side effects, all of which resolved on drug cessation.
Conclusions: This is the largest cohort supporting the favorable safety profile and high efficacy of LDAA in IBD. It presents 2 advances in therapy: prescribing LDAA for thiopurine-naive patients, and bypassing TGN monitoring in favor of clinical monitoring (blood counts, etc.), which will make it more accessible for clinics without access to TGN assays.
Keyword Azathioprine
Allopurinol
Inflammatory bowel disease
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Mater Research Institute-UQ (MRI-UQ)
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Created: Thu, 07 Jul 2016, 11:37:14 EST by Ms Felicity Lindberg on behalf of School of Pharmacy