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Thiopurines Improve Quality of Life for Patients With Inflammatory Bowel Disease


March 3, 2010 — Patients with inflammatory bowel disease (IBD) who undergo thiopurine therapy experience improved quality of life, according to a study published online March 2 in BMC Gastroenterology.

"The efficacy of thiopurines in the scenarios in which they are prescribed, either to induce or to maintain remission in IBD, is well proven," said lead author Guillermo Bastida, MD, from the gastroenterology unit, La Fe Hospital, Valencia, Spain, in a news release. "Their effect on quality of life has been a cause for concern however, with some reports suggesting that they can cause patients to perceive their lives as being more difficult while under treatment."

Thiopurines are natural substances found in the body and most foods. Before the study, adequate data did not exist on the effect of thiopurine treatment on health-related quality of life (HRQoL) in patients with IBD. The goal of the study was to assess the long- and short-term effect of thiopurines on HRQoL in these patients and to explore the association between the clinical and biological aspects of its effects.

Researchers prospectively studied 92 patients in a single Spanish hospital who were diagnosed with 1 of 2 types of IBD: Crohn's disease or ulcerative colitis. All were treated with azathioprine — one of several thiopurines. An initial dose of 50 mg daily was increased within the first month to 2.5 mg/kg, the target dose. A dozen patients with azathioprine intolerance received 6-mercaptopurine treatment. Seven of the 12 patients were taken off that drug because of its toxicity.

Each participant was evaluated for quality of life at the study's onset, at 6 months, and at 1 year, using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the Inflammatory Bowel Disease Questionnaire (IBDQ). The SF-36 consists of 8 dimensions including physical function, emotional problems, mental health, and general health perception. Its scores were shown as a percentage on a scale of 0 (least favorable status) to 100 (most favorable).

The IBDQ is divided into 5 dimensions: bowel symptoms, systemic symptoms, functional impairment, social impairment, and emotional function. Scoring is on a 7-point Likert scale, with 7 describing the best function.

Improvements Continue Over Time

At the beginning of the study, the mean baseline IBDQ score was 4.6 (range, 2.31 - 6.84), with poorer results in all 5 categories for the study population compared with the general population in Spain. The SF-36 results showed a worse quality of life in all 8 sections.

Both measures showed improvements as the study progressed. At 6 months the median IBDQ score (5.8; range, 1.58 - 6.97) showed marked improvement, as did all 5 IBDQ dimensions. Each of the 8 SF-36 categories also saw significant upgrades. At 12 months, the median IBDQ score was 6.1 (range, 2.7 - 6.98), with recovery in all areas compared with baseline and 6-month evaluations. The SF-36 produced a comparable increase in all categories.

"Our study shows that before initiating thiopurines, patients with IBD have greatly impaired perceived health status involving the majority of the aspects of HRQoL," write Dr. Bastida and colleagues. "Furthermore, and more importantly, this study provides evidence of the positive and long-lasting impact of azathioprine and 6-mercaptopurine on all dimensions of HRQoL in patients with IBD."

R. Balfour Sartor, MD, from the University of North Carolina, Chapel Hill, and chief scientific advisor of the Crohn's and Colitis Foundation of America, told Medscape Gastroenterology that the study is unique, and it reinforces his clinical experience. But Dr. Sartor also noted several drawbacks, including multiple differences among the participants' individual cases.

"There were variable-inducing drugs. Some patients had postoperative recurrences and others were nonsurgical," Dr. Sartor said. "So clearly there are limitations in the heterogeneous population, as well as a lack of a control group; you're not comparing it to the other potential maintenance therapies."

Subsequent studies should evaluate the introduction of thiopurines earlier in the progression of IBD and the drug's longer-term effect on quality of life, the study authors note. They also point out the need for more intense physical examination of patients undergoing thiopurine therapy.

"In this study, we did not routinely perform endoscopy," Dr. Bastida and colleagues write. "Another important issue that should be addressed in future investigations is the implications on HRQoL and in the natural history of azathioprine-induced mucosal healing."

UCB-Pharma supported the study. The study authors have disclosed no relevant financial relationships.

BMC Gastroenterol. Published online March 2, 2010.
Authors and Disclosures
Nancy Fowler Larson

Nancy Fowler Larson is a freelance writer for Medscape.


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I love any IBD research..... I just don't have the patience or skills to go hunting after it...(I'm easily frustrated). So I really appreciate people who can find these awesome nuggets of information.
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