Timing of Myelosuppression During Thiopurine Therapy for Inflammatory Bowel Disease: Implications for Monitoring Recommendations

James D. Lewis, Oren Abramson, Monina Pascua, Liyan Liu, Laura M. Asakura, Fernando S. Velayos, Susan Hutfless, James E. Alison, Lisa J. Herrinton

Research output: Contribution to journalArticle

Abstract

Background & Aims: Thiopurines (azathioprine and 6-mercaptopurine) can induce life-threatening myelosuppression. This study determined the frequency, timing, and outcomes of mild and severe myelosuppression after initiation of thiopurine therapy. Methods: This retrospective cohort study included patients with inflammatory bowel disease who were new users of thiopurines; those tested for thiopurine methyltransferase levels before therapy were excluded. Patients were followed from their first thiopurine prescription until the earliest of severe leukopenia (white blood cell count, 9/L), severe thrombocytopenia (platelet level, 9/L), the end of therapy, the first gap in therapy, disenrollment, or December 31, 2006. Results: Among 1997 new users, the incidence of severe leukopenia per 100 person-months was 0.16 (95% confidence interval [CI], 0.03-0.29; n = 6) in weeks 0 to 8, 0.00 in weeks 9 to 24, and 0.01 (95% CI, 0-0.03; n = 3) after week 26 of therapy. The incidence of severe neutropenia and severe thrombocytopenia per 100 person-months during the first 8 weeks of therapy was 0.51 (95% CI, 0.31-0.80; n = 19) and 0.08 (95% CI, 0.02-0.23; n = 3), respectively. During the first 8 weeks, the median duration from a normal white blood cell count to severe leukopenia was 13 days (range, 8-26 d) and to severe neutropenia was 14 days (range, 7-23 d). Conclusions: The high incidence of severe myelosuppression justifies frequent monitoring during the first 8 weeks of therapy. Subsequently, the rate of severe myelosuppression and the proportion of patients who progress from mild to severe myelosuppression decrease, justifying less-frequent monitoring.

Original languageEnglish (US)
Pages (from-to)1195-1201
Number of pages7
JournalClinical Gastroenterology and Hepatology
Volume7
Issue number11
DOIs
StatePublished - Nov 2009

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Inflammatory Bowel Diseases
Leukopenia
Confidence Intervals
thiopurine methyltransferase
Neutropenia
Leukocyte Count
Thrombocytopenia
Therapeutics
Incidence
6-Mercaptopurine
Azathioprine
Prescriptions
Cohort Studies
Blood Platelets
Retrospective Studies

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Timing of Myelosuppression During Thiopurine Therapy for Inflammatory Bowel Disease : Implications for Monitoring Recommendations. / Lewis, James D.; Abramson, Oren; Pascua, Monina; Liu, Liyan; Asakura, Laura M.; Velayos, Fernando S.; Hutfless, Susan; Alison, James E.; Herrinton, Lisa J.

In: Clinical Gastroenterology and Hepatology, Vol. 7, No. 11, 11.2009, p. 1195-1201.

Research output: Contribution to journalArticle

Lewis, James D. ; Abramson, Oren ; Pascua, Monina ; Liu, Liyan ; Asakura, Laura M. ; Velayos, Fernando S. ; Hutfless, Susan ; Alison, James E. ; Herrinton, Lisa J. / Timing of Myelosuppression During Thiopurine Therapy for Inflammatory Bowel Disease : Implications for Monitoring Recommendations. In: Clinical Gastroenterology and Hepatology. 2009 ; Vol. 7, No. 11. pp. 1195-1201.
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AU - Abramson, Oren

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AU - Liu, Liyan

AU - Asakura, Laura M.

AU - Velayos, Fernando S.

AU - Hutfless, Susan

AU - Alison, James E.

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