4.3 Article

Natural history of azathioprine-associated lymphopenia in inflammatory bowel disease patients: a prospective observational study

Journal

EUROPEAN JOURNAL OF GASTROENTEROLOGY & HEPATOLOGY
Volume 23, Issue 2, Pages 153-158

Publisher

LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MEG.0b013e32834233a2

Keywords

azathioprine; Crohn's disease; glutathione-S-transferase M1; inflammatory bowel disease; leucopenia; lymphopenia; neutropenia; opportunistic infections; thiopurines; ulcerative colitis

Funding

  1. NIHR at the Biomedical research centre, University of Manchester, UK

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Introduction Azathioprine (AZA) is commonly used in inflammatory bowel disease (IBD) patients. Lymphopenia is a recognized effect of this treatment, but lymphopenia-related complications in IBD patients have not been widely reported. The incidence and progression of AZA-induced lymphopenia in IBD patients is not well described. There is no consensus on its optimal management in this group. Aims and methods We assessed the incidence and progression of lymphopenia and its related complications in a cohort of IBD patients over a 14-month period in two large tertiary gastroenterology units. Analysis of prospectively collected data was performed. Results Fifty-two patients were studied prospectively with a median age of 34 years. Eighteen patients (34.6%) developed lymphopenia (<1.0 x 10(9)/l) during the course of treatment and 10 of them had severe lymphopenia (<0.6 x 10(9)/l). Lymphopenia lasted on average 85.4 days and spontaneously resolved in 13 patients. No lymphopenia related-complications were documented. Patients treated with steroids had a significantly higher rate of lymphopenia (83.3 vs. 44.1%, P = 0.0083). Conclusion Lymphopenia is common among IBD patients treated with AZA. However, it did not seem to be associated with a higher risk of opportunistic infections and spontaneously resolved in the majority of cases. Eur J Gastroenterol Hepatol 23:153-158 (C) 2011 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.

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