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OP034 The initiation of thiopurines in elderly patients with inflammatory bowel disease is associated with an increased risk of adverse effects: a case–control study of the ENEIDA registry

2018; Oxford University Press; Volume: 12; Issue: supplement_1 Linguagem: Inglês

10.1093/ecco-jcc/jjx180.033

1876-4479

Margalida Calafat, Míriam Mañosa, Fiorella Cañete, Julián Panés, V García Sánchez, Marta Calvo, Francisco Rodríguez‐Moranta, Carlos Taxonera, Pilar Nos, Antonio López Sanromán, María Dolores Martín‐Arranz, Miguel Mínguez, Javier P. Gisbert, Santiago García‐López, Ruth de Francisco, Fernando Gomollón, Xavier Calvet, Esther García-Planella, M. Rivero, J Martínez-Cadilla, Federico Argüelles‐Arias, Lara Arias García, Marta Cimavilla, Yamile Zabana, Lisset Barroso Márquez, Ana Gutiérrez, G Alcaín, P Martínez Montiel, J. L. Lázaro, David Busquets, Mariana Fe García Sepulcre, Cristina Verdejo, Fernando Bermejo, M Mora, David Monfort, Pablo L. Ortiz‐Romero, Benito Velayos, Cristina Rodríguez, A Rodríguez, Olga Merino, A Rodríguez-Pescador, Luís Bujanda, Yolanda Ber, Milagros Vela, Óscar Roncero, José María Huguet, Orlando García-Bosch, Manuel Barreiro‐de Acosta, Rosa Eva Madrigal, Laura Ramos, Manuel Van Domselaar, Pedro Almela, J Llaó, Alfredo J. Lucendo, Carmen Muñoz Vilafranca, Á Abad, Mara Charro, Jesús Legido, J Riera, Sam Khorrami, Eva Sesé, A M Trapero, Eugeni Domènech,

Acute Lymphoblastic Leukemia research

Thiopurines are the most widely used immunosuppressants in inflammatory bowel disease (IBD). However, patients using these drugs present drug-related adverse effects (AE) in 20–30% of cases. In a previous study, we observed a different profile of thiopurine-related AE in elderly-onset IBD. On the other hand, the use of biological agents in elderly patients could be associated with an increased risk of infections, so they are not a clear alternative. Our aim was to evaluate safety of thiopurines in IBD patients according to the age of initiation of treatment. Changes from BL in liqid levels, MACE events and risk factors for MACE in the tofacitinib clinical programme Case–control study including all adult patients of the ENEIDA registry (a large, prospectively maintained database of the Spanish Working Group in IBD –GETECCU) who had received treatment with thiopurines. Patients were grouped regarding the age at the beginning of thiopurine treatment: over 60 years, and between 18 and 50 years of age. Thiopurine-related AE registered in the ENEIDA database were compared between both groups. Out of 48.752 IBD patients included in the ENEIDA database, 17371 (35.6%) had been treated with thiopurines. Of these, 1892 (11%) patients started therapy over the age of 60 years and 15479 (89%) under 50 years of age. Time from IBD diagnosis to the beginning of thiopurines was significantly longer in those who started >60 years (33 months [IQR 7–117] vs. 24 months [IQR 5–85]; p < 0.001). The median treatment duration was significantly shorter in those who started thiopurines >60 years (20.5 [IQR 2–64] vs. 39 [IQR 6–93] months; p < 0.001). Regarding thiopurine-related AE, patients starting >60 years had a significantly higher rate of myelotoxicity (anaemia, leukopoenia, lymphopenia, thrombocytopenia and aplasia), digestive intolerance (nausea and vomiting), infections, hepatotoxicity and neoplasms (p < 0.05). Thiopurines were discontinued due to AE in a significantly higher proportion of patients starting >60 years (35.8% vs. 23.6%, p < 0.001) and also more frequently within the first 3 months of treatment (37.1% vs. 28.2%, p <0.001). The use of thiopurines in elderly IBD patients is associated with an increased risk of AE. Starting thiopurines over 60 years of age should be followed by a closer monitoring, paticularly during the first 3 months, due to the increased risk of developing AE.