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P268. A survey about the use of thiopurines for inflammatory bowel diseases among Italian gastroenterologists

S. Saibeni1, A. Kohn2, G. Meucci3, C. Papi4

1Azienda Ospedaliera Fatebenefratelli E Oftalmico, Department of Internal Medicine and Hepatology, Milan, Italy; 2San Camillo Forlanini Hospitals, U.O. Gastroenterologia, Rome, Italy; 3Ospedeale San Giuseppe, Gastroneterologia, Milan, Italy; 4S. Filippo Neri Hospital, UOC Gastroenterologia & Epatologia, Rome, Italy

Background: Thiopurines are the most commonly employed immunosuppressants in Inflammatory Bowel Disease (IBD); despite this, several discrepancies about their use still remain in clinical practice. Aim of the study is to know the attitudes of Italian gastroenterologists when they treat an IBD patient with thiopurines.

Methods: A 25 items web-based questionnaire was sent to all the 295 gastroenterologists members of the Italian Group for Inflammatory Bowel Disease.

Results: Seventy gastroenterologists (23.7%) completed the survey; 59 out of 70 (84.3%) were working in public hospitals, 38 out of 70 (54.3%) aged between 40 and 59 years and 29 out of 70 (41.4%) managing more than 500 IBD patients. Before starting therapy, the majority do not routinely assess thiopurine methyltransferase (TPMT) genotype (61/70, 87.1%) or phenotype (68/70, 97.1%) and do not care about the possible concomitant assumption of 5‑ASA (51/70, 72.9%). At starting, azathioprine is largely preferred to 6‑mercaptopurine (68/70, 97.1%); the full weight-based dose is immediately adopted by 12 out of 70 (17.1%) while 56 out of 70 (80.0%) adopt an escalation dosage. In case of myelo- and liver toxicity most gastroenterologists reduce the dose (61/70, 87.1% and 45/70, 64.3%; respectively); however, dose is also reduced when increases in pancreatic enzymes (34/70, 48.6%), gastrointestinal symptoms (28/70, 40.0%), fever (12/70, 17.1%), and arthralgias (11/70, 15.7%) occur. Very few gastroenterologists systematically shift from a thiopurine to another in case of failure (3/70, 4.3%) or side effects (4/70; 5.7%). Thiopurines treatment is stopped after 5 to 7 years by the majority (44/70, 62.9%).

Conclusions: Among Italian gastroenterologists, several discrepancies about the use of thiopurines in clinical practice still exist. The deviation from available guidelines is not irrelevant. A more homogeneous attitude is strongly warranted.