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Published byPriscilla Miller
Modified over 2 years ago
Azathioprine for IBD : Better the devil you know Jeremy D. Sanderson
Azathioprine for inducing remission in active IBD 425 patients (209 AZA/6-MP, 216 placebo) End-points: steroid sparing effect, clinical response Overall response Aza/6-MP54% (CI 47%-61%) placebo 33% (CI 27%-40%) Pooled OR2.36 (CI 1.57 – 3.53) Time to respondPresent 1980av. 3.1 months OR 1.54 if <17 weeks Rx OR 2.51 if >17 weeks Rx Steroid sparingAza/6-MP65% (CI 56%-74%) placebo36% (CI 27%-45%) Pooled OR3.86 (CI 2.14 – 6.96) Sandborn et al, Cochrane Library, Issue 4, 2000
Background Azathioprine effective in 70% patients with IBD 30% failure due to:Intolerance 15% No response 15% IntoleranceBone marrow suppression Nausea Myalgia, flu-like symptoms Pancreatitis Hepatotoxicity Other Azathioprine failuresMTX, anti-TNF Surgery
Azathioprine 6-Mercaptopurine 6-thioinosine nucleotide 6-thioguanine nucleotides Thiouric acid 6-Me MP TPMT*** Xanthine oxidase HGPRT IMPDH - - - ImmunosppressionClinical benefit
Intermediate High (Normal) Very High Low
TPMT (thiopurine methyl transferase) allelic polymorphism High TPMT 89% Intermediate TPMT 11% Low TPMT 1/300 ?very high TPMT Severe Bone Marrow Suppression !! High risk of marrow suppression Low risk ? poor responders - + clinical response
Initiate at 100mg Build to 2mg/kg AZA treatment ? Check TPMT Enzyme / genotype Check TPMT Enzyme / genotype Homozygous deficient Heterozygous deficient Normal Initiate at 25mg Build to 1mg/kg Consider 2.5 – 5mg AZA ? Thioguanine Alternative Rx Consider 2.5 – 5mg AZA ? Thioguanine Alternative Rx TolerantIntolerant Very high Flu-like illness Pancreatitis Hepatitis Flu-like illness Pancreatitis Hepatitis Nausea Reduce dose Switch to 6-MP Alternative Rx ? Thioguanine Marrow suppression Reduce dose Check for drugs, 5’-nucleotidase def Parvovirus infection Repeat TPMT 6mo – 1yr. InducedNo change Increase AZAContinue Initiate at 100mg Build to 2.5 – 3mg/kg Non-response…...
Bargain Azathioprine …….. still the best and getting better
IBD medical therapy …… …… the Bridge approach
Crohn’s disease : the Bridge approach Antibiotics Nutritional Rx Steroids Methotrexate Anti-TNF Azathioprine Mycophenolate ?? Methotrexate
Conclusions Many new and potentially exciting therapies for refractory IBD But before you use them …….. Make sure you get the best out of existing approaches
Natalizumab- Unmet Need in the Management of Crohn’s Disease Doug Wolf, M.D. Atlanta Gastroenterology Associates July 31, 2007.
Thiopurines still have a role in the management of pediatric IBD Athos Bousvaros MD, MPH Associate Director, IBD program Boston Children’s Hospital.
Methotrexate Indications and Approaches
6-MP and AZA Applications and Approaches
When can we use combination therapy for our pediatric IBD patients? Athos Bousvaros MD, MPH Advances in IBD Dec 2014.
Immunomodulators and Biologics Maria T. Abreu, MD University of Miami Miller School of Medicine Miami, Florida.
Colitis in the Very Young
You Can Never Stop a Biologic
Immunosuppressive Medications and IBD: Now and What’s Next
Inflammatory Bowel Disease Treatment. Epidemiology Clinical Laboratory Imaging Pathology Response to treatment IBD.
Early Administration of Azathioprine Versus Conventional Management of Crohn’s Disease : A Randomized Controlled Trial F1. Ja Won Koo JACQUES COSNES, ANNE.
Hepatitis web study Hepatitis web study Boceprevir in Treatment Experienced RESPOND-2 Phase 3 Treatment Experienced Bacon BR, et al. N Engl J Med. 2011;364:
Treatment of Vasculitis: immunesuppressives and biologics
Clinical Vignette: Medical Grand Rounds Joshua L. Denson MD Internal Medicine PGY2 January 7, 2013 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.
Improving outcome of Inflammatory Bowel Disease in children Dinesh Pashankar, MD Pediatric Gastroenterologist Director- Pediatric IBD program Yale University.
Emerging treatments in Crohn’s disease and ulcerative colitis
Miguel Regueiro, M.D. Professor of Medicine
Monotherapy using 6-MP or azathioprine for Crohn’s disease is dead: out with the old and in with the new Stephen B. Hanauer, MD Professor of Medicine Clinical.
Inflammatory Bowel Disease Kimberly Persley, MD Digestive Disease Associates of Dallas Presbyterian Hospital of Dallas.
IBD Cases Stephen B. Hanauer, MD Professor of Medicine Feinberg School of Medicine Medical Director, Digestive Health Center.
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