Azathioprine with Allopurinol Is a Promising First-Line Therapy for Inflammatory Bowel Diseases

• DOI: 10.1007/s10620-021-07273-y
• Publication Date: 2021-11-02T17:51:20Z
• Authors: Elsa L. S. A. van...; Ahmed B. Bayoumy; Chris J. J. Mulder; Ben Warner; Bu Hayee; Bilal A. Mateen; Jonathan D. Nolan; Nanne K. H. de Boer; Simon H. C. Anderson; Azhar R. Ansari
• Keywords: Allopurinol; Tolerability; Thiopurine methyltransferase

Beneficial response to first-line immunosuppressive azathioprine in patients with inflammatory bowel disease (IBD) is low due high rates of adverse events. Co-administrating allopurinol has been shown improve tolerability. However, data on this co-therapy as treatment are scarce.Retrospective comparison long-term effectiveness and safety low-dose azathioprine-allopurinol (LDAA) monotherapy (AZAm) IBD without metabolite monitoring.Clinical benefit was defined ongoing therapy initiation steroids, biologics or surgery. Secondary outcomes included CRP, HBI/SCCAI, steroid withdrawal events.In total, 166 LDAA 118 AZAm (median follow-up 25 27 months) were evaluated. Clinical more frequently observed at 6 months (74% vs. 53%, p = 0.0003), 12 (54% 37%, 0.01) the 36 months; 37% 24%, 0.04). Throughout follow-up, 60% likely fail therapy, a higher intolerance rate (45% 26%, 0.001). Only 73% effective AZA dose tolerated patients, while could be initiated maintained its target dose. Incidence myelotoxicity elevated liver enzymes similar both cohorts, conditions led only 2%. Increasing from 100 200-300 mg/day significantly lowered 5/6 hepatotoxicity.Our poor emphasize that optimization needed. We demonstrated safe profile LDAA. This may therefore considered standard immunosuppressive.