Highlights from

ECCO 2019

European Crohn's and Colitis Organisation's 14th congress

Copenhagen 6-9 March 2019

Safety of thiopurine + allopurinol vs thiopurine monotherapy

IBD patients on thiopurine and allopurinol did not have a statistically significant different risk of adverse outcomes (including initiation of a biologic) when compared with IBD patients exposed to thiopurine monotherapy. This conclusion is based on an analysis of a nationwide cohort of Danish IBD patients who had been prescribed thiopurine therapy between 1999 and 2014 [1].

In this period, 10,367 patients with IBD (5,484 Crohn’s disease and 4,883 ulcerative colitis) were prescribed thiopurines; 217 of them used allopurinol co-therapy. The primary outcome was a composite of any adverse outcome or need for biological treatment: IBD-related hospitalisation, IBD-related surgery, biological therapy initiation, or death. In patients exposed to allopurinol co-therapy, there were 40 incident outcomes in 129 person-years (PY) (incidence rate 310.1 per 1,000 PY). In patients exposed to thiopurine monotherapy, 4,745 outcomes among 24,585 PY were observed (incidence rate 193.0 per 1,000 PY). The adjusted incidence rate ratio of an adverse outcome was not significantly different (1.26). The results did not differ when analysed in strata by IBD subtype (i.e. Crohn’s disease or ulcerative colitis). Even though allopurinol co-therapy seems to improve clinical remission in IBD patients in previous studies, the Danish researchers concluded that their study does not suggest an association with subsequent clinical outcomes.

Keywords: Crohn’s disease, ulcerative colitis

  1. Thomsen SB, et al. ECCO 2019, DOP88.

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