mercaptopurine and Behcet-Syndrome

Topics: Adrenal Cortex Hormones; Adrenocorticotropic Hormone; Antibiotics, Antineoplastic; Antilymphocyte Serum; Azathioprine; Behcet Syndrome; Chlorambucil; Choroiditis; Corneal Transplantation; Deafness; Eye Diseases; Graves Disease; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Meningoencephalitis; Mercaptopurine; Multiple Sclerosis; Ophthalmia, Sympathetic; Postoperative Care; Retinal Detachment; Retinal Hemorrhage; Uveitis

The thiopurine drugs, azathioprine (AZA), and 6-mercaptopurine (6-MP) are well-established drugs for the treatment of inflammatory bowel disease (IBD). Although leukopenia is a well-recognized side effect of AZA/6-MP treatment, its association with therapeutic effects has yet to be determined. We therefore evaluated the influences of thiopurine-induced leukopenia on the long-term prognosis of IBD.. We included 196 IBD patients [45 with ulcerative colitis (UC), 68 with Crohn's disease (CD), and 83 with intestinal Behçet's disease (BD)] who were treated with AZA/6-MP and achieved remission between January 2006 and December 2012. We retrospectively analyzed patient characteristics, AZA/6-MP maintenance dose (mg/kg), the lowest white blood cell (WBC) count during AZA/6-MP treatment, duration of remission, and the occurrence of relapse. We compared the clinical variables between leukopenic (n = 120, WBC count <4,000/μL) and nonleukopenic (n = 76, WBC count ≥ 4,000/μL) patients.. The two groups were well matched for baseline clinical characteristics. The cumulative relapse-free survival rate was higher in the leukopenic group than the nonleukopenic group by Kaplan-Meier survival analysis (log-rank test, P < 0.001). On multivariate analysis, age, duration of AZA/6-MP treatment, presence of macrocytosis, and the presence of leukopenia were negatively associated with relapse (odds ratios 0.975, 0.988, 0.563, and 0.390, respectively). On subgroup analysis, the cumulative relapse-free survival rate was significantly higher in the leukopenic group than in the nonleukopenic group for all types of IBDs, including UC, CD, and intestinal BD (log-rank test, P = 0.032, 0.047, and 0.002, respectively).. Leukopenia during thiopurine maintenance therapy was associated with prolonged remission in patients with IBD and Behcet's disease.

Topics: Adolescent; Adult; Aged; Azathioprine; Behcet Syndrome; Colitis, Ulcerative; Comorbidity; Crohn Disease; Female; Humans; Immunosuppressive Agents; Kaplan-Meier Estimate; Leukopenia; Male; Mercaptopurine; Middle Aged; Multivariate Analysis; Prognosis; Remission Induction; Retrospective Studies; Young Adult

Topics: Azathioprine; Behcet Syndrome; Colitis, Ulcerative; Crohn Disease; Female; Humans; Immunosuppressive Agents; Leukopenia; Male; Mercaptopurine

No studies have heretofore specifically focused on the efficacy of postoperative thiopurine therapy in intestinal Behçet's disease (BD). We conducted this study to assess the clinical effects of postoperative thiopurines in patients with intestinal BD.. We reviewed the medical records of all patients with intestinal BD who had undergone bowel resection surgery in a single tertiary academic medical center between 1991 and 2013. The cumulative probabilities of clinical recurrence were calculated using the Kaplan-Meier method, and predictive factors for recurrence were assessed by multivariate analysis.. A total of 77 patients with intestinal BD received 5-ASA (n = 50, 64.9%) or thiopurine (n = 27, 35.1%) therapy after surgery at our center. The postoperative recurrence rate was lower in patients who received postoperative thiopurines (P = 0.050). The hazard ratio for recurrence was 0.636 (95% confidence interval 0.130-1.016, P = 0.053) for postoperative thiopurine use compared with postoperative 5-ASA. However, the rates of re-operation, re-admission, and death were not significantly different between the 5-ASA and thiopurine groups.. Thiopurine therapy after surgery exhibited a modest effect in preventing recurrence in intestinal BD patients. More patients, long-term follow-up, and a randomized controlled design are necessary to validate the effectiveness of postoperative thiopurines in patients with this disease.

Topics: Adolescent; Adult; Aged; Aminosalicylic Acids; Azathioprine; Behcet Syndrome; Female; Humans; Immunosuppressive Agents; Male; Mercaptopurine; Middle Aged; Recurrence; Retrospective Studies; Young Adult

This study was to evaluate the frequency and the course of the adverse effects of AZA/6-MP in Korean patients with inflammatory bowel disease (IBD).. Medical records of the patients with IBD treated with AZA/6-MP at Severance hospital from June 1996 to September 2006 were retrospectively analyzed.. A total of 133 patients were studied. Male to female ratio was 1.3:1. The mean age was 31.7+/-10.9 year. Adverse effects included leukopenia occurred in 75 cases (56.4%), nausea/vomiting in 32 cases (24.1%), arthralgia in 6 cases (4.5%), hepatitis in 6 cases (4.5%), skin rash in 4 cases (3.0%), herpes zoster in 3 cases (2.3%), and headache in 1 case (0.8%). Most of leucopenia (58.7%) developed within 3 months after maximal tolerated dose of AZA/6-MP and nausea/vomiting frequently occurred within 3 months after start of AZA/6-MP treatment. Thirty-eight patients (28.6%) required the discontinuation of medication due to adverse effects.. Leukopenia was the most common adverse effect of AZA/6-MP treatment. Leukopenia and nausea/vomiting developed frequently in the early period of treatment of AZA/6-MP in patients with IBD. AZA/6-MP should be used cautiously to scrutinize bone marrow suppression.

Topics: Adolescent; Adult; Azathioprine; Behcet Syndrome; Cohort Studies; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Inflammatory Bowel Diseases; Leukopenia; Male; Mercaptopurine; Middle Aged; Retrospective Studies; Time Factors

Thirty patients with Behcet's disease were treated with immunosuppressive drugs, 25 with Imuran, 5 with Leukerin and 2 with both these drugs. Daily administration of 50-75 mg of Imuran over a period of 1 year alleviated the ocular symptoms in 16% of patients, was slightly effective in 20%, and ineffective in 64%. Imuran therapy was also seen to alleviate the extraocular pathology, such as stomatitis, erythema, and arthralgia. Leukerin proved difficult to prescribe over a long period because of severe side effects.

Topics: Azathioprine; Behcet Syndrome; Female; Humans; Immunosuppressive Agents; Male; Mercaptopurine