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P228. Awareness of adverse effects of azathioprine among patients with inflammatory bowel disease

R.C. Lee1, D. Keegan2, G.A. Doherty2, H. Mulcahy2, D. O'Donoghue2, S.J. Murphy2

1School of Medicine and Medical Sciences, University College Dublin, Ireland; 2Department of Gastroenterology, St Vincent's University Hospital, Dublin, Ireland

Aim: Azathioprine is an important immunomodulator in the management of Inflammatory Bowel Disease (IBD), particularly in the maintenance of remission. The adverse effects can be significant so it is important to inform patients. We performed a survey to assess patients' understanding of the potential adverse effects of azathioprine.

Materials and Methods: A 10-question survey was completed by consecutive patients with IBD attending the Gastroenterology Outpatient Department at St. Vincent's University Hospital in Dublin from April to October 2010. Patient questionnaires were anonymous. The survey enquired about information received prior to starting the drug, awareness of potential side effects, blood monitoring issues, and action taken if patients had ever felt ill while taking azathioprine.

Results: 61 completed patient questionnaires (33 male, 28 female) were analysed. Thirty-six (54%) patients had Crohn's disease, 22 (36%) ulcerative colitis, and 3 either had indeterminate colitis or were not certain. Thirty-seven (61%) received information about azathioprine from their physician (24% written, 38% verbal, 35% both written and verbal). With regards to compliance, 51 (84%) patients remembered to take their medication every day, 3 (5%) remembered to take it most days of the week, while 13 (21%) did not respond. Of those who answered, 37 (69%) were aware that low WBC counts were a side effect of azathioprine, while 17 (31%) were either not aware or were unsure. Fifty-seven (93%) of patients had blood monitoring performed, but the frequency varied from once per month (14; 25%) to less than once every 12 months (1; 2%). Among respondents, awareness of other side effects was lower (38% for skin rash, 25% for pancreatitis, and 31% for lymphoma). Twenty-six (43%) patients surveyed had felt unwell while taking azathioprine: of these, 10 (38%) experienced a flu-like illness and 8 (31%) had a sore throat with or without fever. As regards action taken during periods of unwell, 17 (65%) visited their GP, 11 (42%) had blood tests done, and 5 (19%) temporarily stopped azathioprine as a result.

Conclusions: Although compliance with azathioprine was high, only 2/3 of patients recalled receiving information regarding the medication and its side effects. Almost all patients surveyed had monitoring for neutropenia performed, but the frequency of monitoring varied widely. Awareness of rare but important side effects such as lymphoma was low. Two-thirds of patients who had felt unwell while on azathioprine visited their GP but only 42% had blood tests performed. These findings emphasise the importance of continuing to remind patients of the adverse effects of azathioprine and the importance of medical attention and blood monitoring if they feel unwell, in addition to regular blood monitoring.