Frequency of Bone Marrow Toxicity by Using Pattern of Azathioprine in Inflammatory Bowel Disease Patients

Hyun, Kyung Hee; Lee, Suck-Ho; Shin, Jae Min; Park, Dong Il; Lee, Chang Kyun; Shin, Jeong Eun; Eun, Chang Soo; Huh, Kyu Chan; Hwangbo, Young

doi:2012.10.3.244

Intest Res > Volume 10(3); 2012 > Article

Original Article

Intestinal Research 2012;10(3):244-250.
DOI: https://doi.org/10.5217/ir.2012.10.3.244 Published online July 31, 2012.

Frequency of Bone Marrow Toxicity by Using Pattern of Azathioprine in Inflammatory Bowel Disease Patients

Kyung Hee Hyun, Suck-Ho Lee, Jae Min Shin, Dong Il Park², Chang Kyun Lee³, Jeong Eun Shin⁴, Chang Soo Eun⁵, Kyu Chan Huh⁶, Young Hwangbo⁷

¹Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan Hospital
²Sungkyunkwan University School of Medicine, Kangbook Samsung Hospital
³Kyunghee University College of Medicine
⁴Dankook University College of Medicine
⁵Hanyang University College of Medicine, Kuri Hospital
⁶Konyang University College of Medicine
⁷Department of Preventive Medicine, Soonchunhyang University College of Medicine

염증성 장질환 환자에서 Azathioprine 사용방법에 따른 골수억제 부작용의 빈도

현경희, 이석호, 신재민, 박동일², 이창균³, 신정은⁴, 은창수⁵, 허규찬⁶, 황보영⁷

¹순천향대학교 의과대학 천안병원
²성균관대학교 의과대학 강북삼성병원
³경희대학교 의과대학
⁴단국대학교 의과대학
⁵한양대학교 의과대학 구리병원
⁶건양대학교 의과대학 내과학교실
⁷순천향대학교 의과대학 예방의학교실

Abstract

Background/Aims
The most important adverse effect of azathioprine (AZA) is bone marrow toxicity (BMT). Many physicians have preferred a gradual dose increment (GDI) policy for the prevention of BMT. The aim of this study was to evaluate the efficacy of GDI for the prevention of AZA-induced BMT in inflammatory bowel disease (IBD) patients. Methods: The medical records of IBD patients who received AZA in 6 university hospitals were reviewed. The patients were divided into two groups: the GDI group (initial dose ＜1.5 mg/kg, gradually increased to a therapeutic dose) and the non-GDI group (initial therapeutic dose ≥2 mg/kg). Results: A total of 308 patients were enrolled (male to female ratio, 1:2.3; mean age, 34.91±14.19 years; ulcerative colitis, 43.5%; Crohn's disease, 55.2%; and intermediate colitis, 1.3%). The overall incidence of BMT was 16.2% (50/308). BMT developed most frequently between fourth to eighth week (26%, 13/50). The rate of BMT of the non-GDI group was significantly higher than that of the GDI group (27.5%, 11/40 vs. 14.6%, 39/268, P=0.038). A multivariate analysis showed that the only factor related to BMT was a non-GDI policy (P=0.036; odds ratio, 2.41; 95% confidence interval, 1.06-5.49). Conclusions: A GDI policy could be useful for reducing AZA-induced BMT in Korean IBD patients. (Intest Res 2012;10: 0-250)

Key Words: Inflammatory Bowel Diseases, Azathioprine, Bone Marrow Toxicity