Prospective study of the effects of concomitant medications on thiopurine metabolism in inflammatory bowel disease


Dr M. Daperno, S.C. Gastroenterologia, A.O. Ordine Mauriziano, Largo Turati 62, 10128 Torino, Italy.


Aliment Pharmacol Ther30, 843–853


Background  Thiopurines are increasingly used in the treatment of inflammatory bowel disease (IBD), being the most common immunosuppressive therapy; however, potentially harmful interactions between thiopurines and other drugs (especially 5-aminosalicylic acid, 5-ASA) were described.

Aim  To explore potential interactions between thiopurines and concomitant medications.

Methods  A total of 183 consecutive IBD patients were enrolled. Clinical characteristics and concomitant medications were recorded. Thiopurine metabolism was analysed with thiopurine S-methyl transferase (TPMT) genetic variants and enzyme activity assays. Comparisons were carried out with stratification of patients according to clinical characteristics and active treatments.

Results  Based on TPMT genetics, 95% IBD patients were wild-type homozygous, the remaining being heterozygous. Median TPMT activity was 24.9 U/Hgb g (IQR 20.7–29.5). No difference in TPMT activity was noted according to 5-ASA exposure. IBD patients on thiopurines had higher TPMT activity levels, but no dose-effect was evident. No difference in TPMT activity was observed in 41 (63%) patients co-treated with 5-ASA. In patients on active thiopurines also, 6-TGN and 6-MMP levels were evaluated and no significant difference was observed based on co-medication. TPMT activity was independently associated only with thiopurines dose (= 0.016).

Conclusions  Our data suggest the absence of significant interactions between thiopurines and 5-ASA.