Increased risk of thiopurine-related adverse events in elderly patients with IBD.

Abstract

Thiopurines are the most widely used immunosuppressants in IBD although drug-related adverse events (AE) occur in 20%-30% of cases. To evaluate the safety of thiopurines in elderly IBD patients METHODS: Cohort study including all adult patients in the ENEIDA registry who received thiopurines. Patients were grouped in terms of age at the beginning of thiopurine treatment, specifically in those who started thiopurines over 60years or between 18 and 50years of age. Thiopurine-related AEs registered in the ENEIDA database were compared. Out of 48752 patients, 1888 started thiopurines when over 60years of age and 15477 under 50years of age. Median treatment duration was significantly shorter for those who started thiopurines >60years (13 [IQR 2-55] vs 32 [IQR 5-82] months; P <.001). Patients starting >60years had higher rates of all types of myelotoxicity, digestive intolerance and hepatotoxicity. Thiopurines were discontinued due to AEs (excluding malignancies and infections) in more patients starting >60years (67.2% vs 63.1%; P <.001). Elderly age and female sex were independent risk factors for most AEs. In elderly IBD patients, thiopurines are associated with an increased risk of non-infectious, non-neoplastic, AEs.