Indicators of clinical response to treatment with six-mercaptopurine or azathioprine in patients with inflammatory bowel disease

被引:41
作者
Achkar, JP
Stevens, T
Easley, K
Brzezinski, A
Seidner, D
Lashner, B
机构
[1] Cleveland Clin Fdn, Ctr Inflammatory Bowel Dis, Dept Gastroenterol, Cleveland, OH 44195 USA
[2] Cleveland Clin Fdn, Ctr Inflammatory Bowel Dis, Dept Biostat, Cleveland, OH 44195 USA
[3] Emory Univ, Rollins Sch Publ Hlth, Dept Biostat, Atlanta, GA 30322 USA
关键词
six-mercaptopurine; azathioprine; six-thioguarine nucleotides;
D O I
10.1097/00054725-200407000-00003
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Objectives: There is some uncertainty regarding how to best dose and therapeutically monitor 6-mercaptopurine or azathioprine in patients with inflammatory bowel disease. The purpose of this study was to assess the relation between clinical response, 6-mercaptopurine metabolite levels, relative leukopenia, and drug dose. Methods: 60 patients with inflammatory bowel disease who were on stable doses of 6-mercaptopurine or azathioprine for 3 months and who had measurements of 6-mercaptopurine metabolite levels were evaluated. Patients were classified as complete responders (N = 24), partial responders (N = 7), or non-responders (N = 29). Results: Drug dose was associated with clinical response when we analyzed adjusted doses based on molecular drug weight (P = 0.002). 6-Thioguanine levels also were associated with clinical response (P = 0.003) and the maximal difference between responders and non-responders was seen at 6-thioguanine levels greater than 260 pmol/8 x 10(8) RBC. Relative leukopenia, defined as white blood cell count less than either 5.0 or 4.0 K/uL, was not associated with clinical response (P = 0.13 and 0.77 respectively). Conclusions: 1. Drug dose and 6-thioguanine levels are related to clinical response in patients with inflammatory bowel disease on 6-mercaptopurine or azathioprine. 2. For 6-thioguanine levels, there is a fair amount of overlap, but maximal differentiation between responders and non-responders is seen at levels > 260 pmol/8 x 10(8) RBC. 3. Relative leukopenia does not correlate well with clinical response.
引用
收藏
页码:339 / 345
页数:7
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