November 12, 2014
Notes: Layer, P
Dellinger, E P
Forsmark, C E
Siriwardena, A K
Whitcomb, D C
Windsor, J A
Petrov, M S
Z Gastroenterol. 2013 Jun;51(6):544-50. doi: 10.1055/s-0033-1335526. Epub 2013 Jun 5.
Author Address: Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland. firstname.lastname@example.org
Reference Type: Journal Article
Record Number: 5149Author: Ledder, O. D., Lemberg, D. A., Ooi, C. Y. and Day, A. S.
Title: Are thiopurines always contraindicated after thiopurine-induced pancreatitis in inflammatory bowel disease?
Journal: J Pediatr Gastroenterol Nutr
Short Title: Are thiopurines always contraindicated after thiopurine-induced pancreatitis in inflammatory bowel disease?
Alternate Journal: Journal of pediatric gastroenterology and nutrition
ISSN: 1536-4801 (Electronic)
Accession Number: 23783022
Keywords: 6-Mercaptopurine/adverse effects/*therapeutic use
Azathioprine/adverse effects/*contraindications/therapeutic use
Crohn Disease/*drug therapy
Immunosuppressive Agents/adverse effects/*contraindications/*therapeutic use
Inflammatory Bowel Diseases/drug therapy
Pancreatitis/*chemically induced/prevention & control
Recurrence/prevention & control
Abstract: BACKGROUND AND AIMS: Thiopurine use in inflammatory bowel disease (IBD) is well established for maintenance of disease remission. Approximately 3% of patients with IBD develop thiopurine-induced pancreatitis (TIP) as an idiosyncratic reaction. Patients diagnosed as having TIP are largely considered not to be candidates for future use of this drug. We hypothesize that previous TIP is not an absolute contraindication to retrialing a different thiopurine. METHODS: This case series is a retrospective chart review of those patients with IBD in whom thiopurines were successfully reintroduced following suspected TIP. The patients were all cared for in 2 Australasian pediatric IBD services. Four cases are presented of TIP appropriately related temporally to azathioprine commencement, with no other apparent cause of pancreatitis identified. All of these patients were trialled on 6-mercaptopurine according to clinical need and this was well tolerated in all cases. RESULTS AND CONCLUSIONS: This report is the largest case series to date focusing on the reintroduction of a thiopurine following suspected thiopurine induced pancreatitis. All of the patients had a typical presentation of TIP. This case series should call into question the assumption that suspected TIP is an absolute contraindication for the future use of this class of drug. Cautious reintroduction of a thiopurine, in a controlled setting, should be considered in certain circumstances. The clinical relevance of this option is most marked in patients with complicated disease requiring long-term immunosuppression, in whom other therapies are poorly tolerated or contraindicated.