Introduction Reports from specialist inflammatory bowel disease (IBD) units have demonstrated that allopurinol and low-dose thiopurine co-therapy is an effective treatment option in patients who have failed standard dose therapy. There is little experience however from the district general hospital (DGH) setting. Co-therapy was introduced in our unit in September 2010.
Aim To evaluate the safety and therapeutic outcome of IBD patients treated with azathioprine and allopurinol co-therapy at our institution.
Methods A prospective database of all patients treated with allopurinol co-therapy is maintained at our institution. We reviewed the database entries and case notes of all patients. Data from patients who had been on allopurinol for <3 months were disregarded.
Results 25 patients were identified, five were excluded because of insufficient follow-up (<3 months) and one patient was lost to follow-up. The median length of co-therapy was 9 (range 3–12) months. Diagnosis was ulcerative colitis (12), Crohn's disease (7), IBD-Unclassified (1). Indications for co-therapy were abnormal LFTs (3), drug side effects (8), high methylmercaptopurine (5), gout (2), therapeutic failure (2). 6-thioguanine nucleotide levels were measured where appropriate in patients before co-therapy, of these 50.0% were therapeutic. Following co-therapy 6-thioguanine nucleotide levels were therapeutic in 81.8% of patients. Co-therapy was effective and well tolerated in 13 (68.4%). Two (10%) patients developed side effects from allopurinol both had been treated with 200 mg od, in one patient (50%) symptoms resolved with dose reduction.
Conclusion We have previously published our long-term outcome data of IBD patients treated with thiopurines; 55% of these patients stopped thiopurine therapy due to therapeutic failure or side effects. The current data demonstrate that the majority of this refractory group can be rescued with co-therapy. These data demonstrate that co-therapy is a safe and effective treatment option in the DGH setting.
Competing interests None declared.
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