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* = Presenting author

P337 Profile and outcomes of mercaptopurine therapy in inflammatory bowel disease

F. Berrmejo*1, A. Algaba1, S. López-Durán2, I. Guerra1, M. Aicart2, M. de Lucas1, E. Garrido2, M. Hernández1, A. López-Sanromán2

1Hospital Universitario de Fuenlabrada, Gastroenterology, Madrid, Spain, 2Hospital Universitario Ramón y Cajal, Gastroenterology, Madrid, Spain

Background

Mercaptopurine (MP) is less used in Spain than azathioprine (AZA). Our aim was to determine the main situations in which MP is used as immunomodulatory therapy in inflammatory bowel disease (IBD), either as first choice thiopurine or as a second choice after AZA, as well as describing its efficacy and safety

Methods

Retrospective observational study in which all cases of patients treated with MP in a total cohort of 1598 patients with IBD were included: 851 patients with Crohn's disease (CD), 676 ulcerative colitis (UC) and 47 colitis non-classified (CNC). Demographics and clinical data regarding IBD and its treatment were collected

Results

Out of 1598 patients, 60.1% (n = 961) had been treated with thiopurines at some time. Of these, 151 patients received MP (98 CD, 51 UC, 2 CNC, 51% female, 25.9% smokers, mean age 49 ± 15 y); this represents 9.4% of all patients with IBD, and 15.7% of patients treated with thiopurines. The median time from diagnosis of IBD to the start of MP was 81 months (IQR: 20-109) and the mean dose used 80 ± 29 mg/d. MP was the initial thiopurine chosen in 14.1% of patients; in 4.5% it was indicated after AZA failure, and in 80.5% it was prescribed as continuation thiopurine following AZA intolerance: 36.9% (n = 48) digestive intolerance, 35.4% (n = 46) hepatotoxicity , 2.3% (n = 3) myelotoxicity, 1.5% (n = 2) pancreatitis and 23.8% (n = 31) other adverse effects. In 80/151 patients (53%; 47 EC, 33 CU), adverse effects of MP appeared, resulting in withdrawal in 50 of them; in one third, the adverse effect was identical to the one suffered after AZA. MP treatment was effective in 39% of cases (95%CI 31- 47%), 41% efficacy in EC, 35% in CU. In the remaining, failure was due to withdrawal due to side effects (49.5%), need for therapeutic step increase (35.9%), need for surgery (12.4%) or supply problems (1.1%). The average total time of MP treatment was 36 months (IQR: 2-60), during which 31 patients (20.5%) required hospitalization and eventually almost half discontinued treatment with MP (47.7 %, of which 11.1% later resumed treatment)

Conclusion

In our setting, MP is primarily used as rescue therapy in patients with AZA adverse effects, which could explain its modest efficacy and the high rate of adverse effects. However, this drug is still an alternative in this group of patients, before a therapeutic step-up to biologics is considered