Mallorca, Spain.
Barcelona, Spain.
Aliment Pharmacol Ther. 2019 Oct;50(7):780-788. doi: 10.1111/apt.15458. Epub 2019 Aug 19.
Thiopurines are the most widely used immunosuppressants in IBD although drug-related adverse events (AE) occur in 20%-30% of cases.
To evaluate the safety of thiopurines in elderly IBD patients METHODS: Cohort study including all adult patients in the ENEIDA registry who received thiopurines. Patients were grouped in terms of age at the beginning of thiopurine treatment, specifically in those who started thiopurines over 60 years or between 18 and 50 years of age. Thiopurine-related AEs registered in the ENEIDA database were compared.
Out of 48 752 patients, 1888 started thiopurines when over 60 years of age and 15 477 under 50 years of age. Median treatment duration was significantly shorter for those who started thiopurines >60 years (13 [IQR 2-55] vs 32 [IQR 5-82] months; P < .001). Patients starting >60 years had higher rates of all types of myelotoxicity, digestive intolerance and hepatotoxicity. Thiopurines were discontinued due to AEs (excluding malignancies and infections) in more patients starting >60 years (67.2% vs 63.1%; P < .001). Elderly age and female sex were independent risk factors for most AEs.
In elderly IBD patients, thiopurines are associated with an increased risk of non-infectious, non-neoplastic, AEs.
尽管在 20%-30%的病例中会发生与药物相关的不良反应 (AE)，但硫嘌呤仍是 IBD 中最广泛使用的免疫抑制剂。
评估老年 IBD 患者使用硫嘌呤的安全性。
该队列研究纳入了 ENEIDA 注册中心接受硫嘌呤治疗的所有成年患者。根据硫嘌呤治疗开始时的年龄将患者分组，具体分为年龄超过 60 岁和 18-50 岁开始使用硫嘌呤的患者。比较了在 ENEIDA 数据库中登记的硫嘌呤相关 AE。
在 48752 例患者中，1888 例年龄超过 60 岁开始使用硫嘌呤，15477 例年龄低于 50 岁开始使用硫嘌呤。起始硫嘌呤治疗>60 岁的患者中位治疗持续时间明显更短[13（IQR 2-55）比 32（IQR 5-82）个月；P<0.001]。起始>60 岁的患者发生各种骨髓毒性、消化不耐受和肝毒性的比例更高。由于 AE（不包括恶性肿瘤和感染）而停止使用硫嘌呤的患者更多起始>60 岁（67.2%比 63.1%；P<0.001）。老年和女性是大多数 AE 的独立危险因素。
在老年 IBD 患者中，硫嘌呤与非传染性、非肿瘤性 AE 的风险增加相关。
