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Inicio Gastroenterología y Hepatología (English Edition) Optimization of azathioprine dose in combined treatment with anti-TNF-alpha in i...
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Vol. 44. Issue 5.
Pages 337-345 (May 2021)
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Vol. 44. Issue 5.
Pages 337-345 (May 2021)
Original Article
DOI: 10.1016/j.gastre.2021.04.002
Optimization of azathioprine dose in combined treatment with anti-TNF-alpha in inflammatory bowel disease
Optimización de la dosis de azatioprina en tratamiento combinado con fármacos anti-TNF en la enfermedad inflamatoria intestinal
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Javier Lucas Ramos
Corresponding author
jlucasr77@gmail.com

Corresponding author.
, Cristina Suárez Ferrer, Joaquín Poza Cordón, María Sánchez Azofra, Jose Luis Rueda García, Eduardo Martin Arranz, Jorge Yebra Carmona, Irene Andaluz García, Maria Dolores Martín Arranz
Hospital Universitario La Paz, Madrid, Spain
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Tables (3)
Table 1. Baseline data of patients according to treatment with infliximab or adalimumab.
Table 2. Descriptive Analysis Infliximab.
Table 3. Descriptive analysis adalimumab.
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Abstract
Introduction

The dose of thiopurine drugs in combined treatments with anti-TNF in inflammatory bowel disease (IBD) has not been clearly established. The purpose of this study is to assess whether the dose of azathioprine influences clinical and biochemical response/remission rates, and anti-TNF drug levels/antibody formation.

Material and methods

Patients with IBD on combined maintenance treatment with azathioprine and infliximab or adalimumab were selected. Based on the dose of azathioprine, two groups were defined (standard: 2–2.5mg/kg/day; and decreased: less than 2mg/kg/day).

Results

In the IFX group, there were no statistically significant differences (p=0.204) in the rates of remission (39% vs 41.3%), response (10% vs 21.7%) or failure (51.5% vs 37%) depending on the dose of thiopurine drugs. No differences were found between AZA-dose dependent IFX levels (2.46 vs 3.21μg/mL; p=0.211). In the adalimumab group, there were no statistically significant differences (p=0.83) in the rates of remission (66% vs 56%), response without remission (15.38% vs 25%) or failure (18% vs 18%) depending on the dose of thiopurines. With respect to ADA-levels, no differences were found in both groups (7.69 vs 8.23μg/mL; p=0.37).

Conclusion

In our experience, no statistically significant differences were found in either anti-TNF levels or clinical-biological response/remission rates based on doses of azathioprine.

Keywords:
Azathioprine
Anti-TNF
Combined treatment
Optimization
Resumen
Introducción

La dosis adecuada de los fármacos tiopurínicos en tratamientos combinados con anti-TNF en la enfermedad inflamatoria intestinal (EII) no ha sido establecida con claridad. El propósito de este estudio es evaluar si la dosis de azatioprina influye en las tasas de respuesta/remisión clínica y bioquímica y en los niveles de fármaco anti-TNF/formación de anticuerpos.

Material y métodos

Se seleccionaron pacientes con EII en tratamiento combinado de mantenimiento con azatioprina (AZA) e infliximab (IFX) o adalimumab (ADA). En función de la dosis de AZA, se definieron dos grupos (estándar: 2-2,5 mg/kg/día o disminuida: menos de 2 mg/kg/día).

Resultados

En el grupo IFX no hubo diferencias estadísticamente significativas (p = 0,204) en las tasas de remisión (39 vs. 41,3%), respuesta (10 vs. 21,7%) o fracaso (51,5 vs. 37%), dependiendo de la dosis de fármacos tiopurínicos. No se encontraron diferencias entre los niveles de IFX dependientes de la dosis de AZA (2,46 vs. 3,21 μg/mL; p = 0,211). En el grupo de ADA no hubo diferencias estadísticamente significativas (p = 0,83) en las tasas de remisión (66 vs. 56%), respuesta sin remisión (15,38 vs. 25%) o fallo (18 vs. 18%), dependiendo de la dosis de tiopurinas. Con respecto a los niveles de ADA, no se encontraron diferencias en ambos grupos (7,69 vs. 8,23 μg/mL; p = 0,37).

Conclusión

En nuestra experiencia, no se encontraron diferencias estadísticamente significativas ni en los niveles de anti-TNF ni en las tasas de respuesta/remisión clínico-biológica basadas en las dosis de azatioprina.

Palabras clave:
Azatioprina
Anti-TNF
Tratamiento combinado
Optimización

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