Successful pregnancies with thiopurine-allopurinol co-therapy for inflammatory bowel disease

Sheikh, Mohammed, Nelson-Piercy, Catherine, Duley, John, Florin, Timothy and Ansari, Azhar (2015) Successful pregnancies with thiopurine-allopurinol co-therapy for inflammatory bowel disease. Journal of Crohns and Colitis, 9 8: 680-684. doi:10.1093/ecco-jcc/jjv072

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Author Sheikh, Mohammed
Nelson-Piercy, Catherine
Duley, John
Florin, Timothy
Ansari, Azhar
Title Successful pregnancies with thiopurine-allopurinol co-therapy for inflammatory bowel disease
Journal name Journal of Crohns and Colitis   Check publisher's open access policy
ISSN 1873-9946
Publication date 2015-05-04
Year available 2015
Sub-type Article (original research)
DOI 10.1093/ecco-jcc/jjv072
Open Access Status File (Author Post-print)
Volume 9
Issue 8
Start page 680
End page 684
Total pages 5
Place of publication Oxford, United Kingdom
Publisher Oxford University Press
Language eng
Formatted abstract
Background: Thiopurines are an effective treatment for moderate to severe inflammatory bowel disease [IBD] and can be used safely in pregnancy. Combining allopurinol with a lower dose of thiopurine can improve clinical efficacy and bypass some adverse reactions associated with thiopurine monotherapy. Data on allopurinol in pregnancy are scarce. We report on a total of 13 cases where thiopurine and allopurinol co-therapy was used successfully to manage IBD during pregnancy without attributable adverse fetal effects.

Patients were retrospectively identified at our two hospitals, one in the UK and one in Australia, using local IBD databases. Data regarding pregnancy and fetal outcomes including in utero fetal ultrasound scans, APGAR scores, fetal birthweights and neonate checks were collected from patient notes.

We identified 12 women with a total of 13 pregnancies treated with co-therapy before conception and for the duration of pregnancy. There were no miscarriages or spontaneous pre-term deliveries. There were 14 live births [seven vaginal deliveries; six caesarean sections]. Except for a primagravid twin pregnancy complicated by pre-eclampsia and twin-to-twin transfusion syndrome requiring caesarean section at 25 weeks, there were no low birthweight [< 2.5 kg] babies born and the APGAR scores of all babies were normal. No congenital malformations were identified.

Adverse pregnancy outcomes attributable to thiopurine and allopurinol co-therapy were not detected in our case series. Our study provides reassurance for clinicians and patients who wish to continue the thiopurine-allopurinol co-therapy combination before conception and during pregnancy to maintain remission of IBD.
Keyword Thiopurine
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Medicine Publications
School of Pharmacy Publications
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Created: Thu, 04 Jun 2015, 03:03:36 EST by Dr John Duley on behalf of School of Pharmacy