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| |  Systematic Determination of Azathioprine Metabolites Does Not Predict Response to Treatment in Inflammatory Bowel Disease: Presented at ECCO-IBD By Karen Dente, MD HAMBURG, Germany -- February 9, 2009 -- Determination of azathioprine metabolites at the beginning of thiopurinic therapy is not useful to predict the response to treatment with azathioprine and mercaptopurine in patients with inflammatory bowel disease (IBD), according to study findings reported here at the 4th Congress of the European Crohn's and Colitis Organisation (ECCO-IBD). Yago Gonzalez-Lama, MD, La Princesa and Getafe Hospitals, Madrid, Spain, led the prospective, multicentre study on behalf of the Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa. "Most studies until now looking at thiopurine therapy have had many limitations, such as small sample sizes," said Dr. Gonzalez-Lama in a presentation on February 6. To assess the utility of 6-thioguanine nucleotide (6TGN) and 6-methylmercaptopurine ribonucleotide (6MMPR) levels as markers or predictors of treatment success in patients with IBD receiving thiopurinic therapy, Dr. Gonzalez-Lama and colleagues monitored azathioprine metabolites periodically during steroid tapering or after withdrawal until a new flare or for 6 months in patients showing maintenance of a clinical response. The 153 patients in the study were divided equally between the sexes and their mean age was 36 years. Almost three-quarters had Crohn's disease. There was no significant difference between patients with and without clinical remission in terms of their mean 6TGN levels at any evaluation time point. No useful cut-off point was found for sensitivity or specificity values using receiver operating characteristic (ROC) analysis. The area under the ROC curve evaluating the accuracy of 6TGN levels for the diagnosis of clinical response for each monitoring point was <0.7. Nine (6%) patients developed thiopurinic-associated toxicity, 3 (2%) reported myelotoxicity; no patient had evidence of hepatotoxicity. "Systematic quantification of thiopurinic metabolites [6TGN/6MMPR] in IBD patients receiving azathioprine and mercaptopurine with the aim of predicting or assessing treatment response or safety cannot be recommended," the research team concluded.
[Presentation title: Lack of Usefulness of Systematic Determination of Azathioprine (AZA) Metabolites During Follow-Up of Inflammatory Bowel Disease (IBD) Patients Under Thiopurinic Therapy: Final Results of the Metaza Study. Abstract 11]
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