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Tioguanine, LDTA may be considered in IBD patients intolerant to conventional thiopurines

21 May 2020

Both tioguanine and low‐dose thiopurines combined with allopurinol (LDTA) may be safely used in the treatment of inflammatory bowel disease (IBD) patients who have failed conventional thiopurines due to intolerance, a study has found.

The analysis included 182 IBD patients who initiated tioguanine (n=94) or LDTA (n=88) after failing conventional thiopurines due to adverse events (AEs). None of the patients were on concomitant biologic therapies.

Patients on tioguanine vs LDTA had a higher C-reactive protein at baseline (4 vs 1.9 mg/L) and were more likely to be using concomitant corticosteroids at baseline (31.9 percent vs 14.0 percent; p=0.005). The median dose at initiation was 20 mg for tioguanine and 100 mg allopurinol with either 50 mg azathioprine or 25 mg mercaptopurine for LDTA.

Over a median follow‐up of 104 weeks, the primary outcome of treatment discontinuation due to AEs occurred in 20 percent of patient on tioguanine and in 18 percent of those on LDTA.

Multiple logistic regression analysis revealed no significant between-group differences in terms of the following safety outcomes: AEs leading to discontinuation (odds ratio [OR], 0.50, 95 percent confidence interval [CI], 0.15–1.68; p=0.26), total AEs (OR, 0.89, 95 percent CI, 0.44–1.81; p=0.75), infections (OR, 1.05, 95 percent CI, 0.40–2.73; p=0.93), hospitalizations (OR, 2.00, 95 percent CI, 0.64–6.23; p=0.23) or clinical remission (OR, 0.74, 95 percent CI, 0.33–1.68; p=0.48). All results were consistent in the propensity score-matched cohort.

The present data indicate that both tioguanine and LDTA provide an additional therapeutic option in selected IBD patients before escalating to biological treatment, researchers said.

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