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Title: 6-Mercaptopurine in the management of inflammatory bowel disease: short- and long-term toxicity.
Title Abreviation: Ann Intern Med Date of Pub: 1989 Oct 15
Author: Present DH; Meltzer SJ; Krumholz MP; Wolke A; Korelitz BI;
Issue/Part/Supplement: 8 Volume Issue: 111 Pagination: 641-9
MESH Headings: Adolescence; Adult; Aged; Bone Marrow Diseases (CI); Child; Colitis, Ulcerative (*DT); Crohn Disease (*DT); Double-Blind Method; Drug Hypersensitivity (ET); Female; Follow-Up Studies; Hepatitis, Toxic (ET); Human; Infection (EP); Male; Middle Age; Neoplasms (EP); Pancreatitis (CI); Pregnancy; Time Factors; 6-Mercaptopurine (*AE/TU);
Journal Title Code: 5A6 Publication Type: JOURNAL ARTICLE
Date of Entry: 891030NEntry Month: 9001
Country: UNITED STATES Index Priority: 1
Language: Eng Unique Identifier: 90024693
Unique Identifier: 90024693 ISSN: 0003-4819
Abstract: We assess toxicity related to 6-mercaptopurine in the treatment of inflammatory bowel disease by reporting our experience with 396 patients (120 patients with ulcerative colitis, 276 with Crohn disease) observed over 18 years. Follow-up data for a mean period of 60.3 months were obtained for 90% of the patients. Toxicity directly induced by 6-mercaptopurine included pancreatitis in 13 patients (3.3%), bone marrow depression in 8 (2%), allergic reactions in 8 (2%), and drug hepatitis in 1 (0.3%). These complications were reversible in all cases with no mortality. Most cases of marrow depression occurred earlier in our experience, when the initial drug doses used were higher. Infectious complications were seen in 29 patients (7.4%), of which 7 (1.8%) were severe, including one instance of herpes zoster encephalitis. All infections were reversible with no deaths. Twelve neoplasms (3.1%) were observed, but only 1 (0.3%), a diffuse histiocytic lymphoma of the brain, had a probable association with the use of 6-mercaptopurine. Our data, showing a low incidence of toxicity in 396 patients, coupled with the previously demonstrated efficacy of 6-mercaptopurine in the treatment of inflammatory bowel disease, indicate that the drug is a reasonable alternative in the management of patients with intractable inflammatory bowel disease.
Abstract By: Author
Address: Lenox Hill Hospital, New York, New York.