P595 Finding predictors of azathioprine-induced pancreatitis in patients with inflammatory bowel disease

Freitas, M.(1,2,3);Capela, T.(1,2,3);Macedo Silva, V.(1,2,3);Arieira, C.(1,2,3);Cúrdia Gonçalves, T.(1,2,3);Dias de Castro, F.(1,2,3);Moreira, M.J.(1,2,3);Cotter, J.(1,2,3);

(1)Hospital da Senhora da Oliveira, Gastroenterology Department, Guimarães, Portugal;(2)Life and Health Sciences Research Institute ICVS, School of Medicine- University of Minho, Braga, Portugal;(3)ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal


Azathioprine (AZA)-induced pancreatitis (AIP) is a common, idiosyncratic side effect, whose incidence, clinical course and risk factors data in inflammatory bowel disease (IBD) patients are scarce. We aimed to establish the incidence, describe the clinical course and identify risk factors for AIP.


Retrospective study including all IBD patients on AZA between January 2013 and July 2020. Patients with AIP were considered. Demographic, clinical, biochemical and imaging data were collected.


AIP occurred in 33 patients (7.5%; 442 patients on AZA): 81.8% had Crohn’s disease, 54.5% were male, and the mean age was 35±13 years. The mean time under AZA till AIP was 25±11 days, with a mean dosage of 88±44mg. Eighteen patients (54.4%) were hospitalized, with a mean hospital stay of 4±2days. All patients had a mild course of disease which resolved with suspension of AZA, and with no complications or need of invasive interventions or complications. Smoking (p=0.02), single daily dose of AZA (p<0.001) and concomitant treatment with budesonide (p=0.001) were risk factors for AIP. In multivariate analysis, concomitant treatment with budesonide (OR: 5.3; p=0.002) and single daily dose of AZA (OR: 4.8; p=0.002) were the only predictors of AIP.


Although AIP was a relatively common side effect, it presented a mild course in all patients. Smoking, concomitant treatment with budesonide and single daily dose of AZA were risk factors for AIP. This study suggests that smoking, concomitant use of budesonide and single dose regimen of AZA should be avoided in IBD patients treated with AZA.