6-Mercaptopurine Side Effect Profile in the Elderly Inflammatory Bowel Disease Patient

Abstract

A total of 77 million baby boomers will join the category of elderly over the next 19 years, at a rate of 4 million per year. The elderly inflammatory bowel disease patient is under represented in clinical trials and often clinicians make decisions using data from such trials involving a much younger patient populations. We set out to investigate the safety of 6-Mercaptopurine in our elderly patient population. Using an electronic search database we identified 41 patients with Inflammatory Bowel disease on 6-Mercaptopurine/Azathioprine with either Ulcerative colitis (UC) or Crohn's disease (CD). A comparison of the dosage, side effect profile, and duration of therapy was examined. Of 41 patients with inflammatory bowel disease, 26 were female and 25 were male. The mean age of the patient population was 70.4 years old. Twenty-five patients were diagnosed with CD and 16 with UC. The dosage of 6-MP ranged from 25 mg to 150 mg. The average duration of therapy was 48.5 months. Thirty patients experienced a single side effect, whereas 8 had multiple occurrences. Four patients had to discontinue therapy (1 rash, 1 hepatitis & rash, 1 pancytopenia, 1 infection) secondary to a severe side effect. The other 26 patients continued their therapy at the current dose, or tolerated therapy after lowering dosage. Two patients developed malignancies while on 6-MP(1 Basal Cell Carcinoma& Squamous Cell Skin Cancer, 1 Bladder Cancer & Prostate Cancer). Our experience demonstrates of 41 patients with inflammatory bowel disease 37/41 (90.2%) were able to tolerate the medication without having to discontinue treatment. Of those with side effects 26/30 (86.7%) were able to continue 6-MP/Azathioprine In our elderly IBD patient population taking immunomodulators that with periodic measurement of CBC, creatinine, and hepatic profile long-term therapy remained beneficial.