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  • Title: Adherence to thiopurine treatment in out-patients with Crohn's disease.
    Author: Bokemeyer B, Teml A, Roggel C, Hartmann P, Fischer C, Schaeffeler E, Schwab M.
    Journal: Aliment Pharmacol Ther; 2007 Jul 15; 26(2):217-25. PubMed ID: 17593067.
    Abstract:
    BACKGROUND: High frequency of incomplete or non-response to azathioprine (AZA) and/or mercaptopurine (MP) limit their use in Crohn's disease (CD). Non-adherence is considered to be of relevance for ineffectiveness. AIM: To assess adherence to thiopurines in CD out-patients treated in a single gastroenterology practice. METHODS: Patients were eligible for inclusion if they received AZA/MP for at least 3 months. After follow-up of 3 months, adherence to AZA/MP was assessed by quantitation of relevant thiopurine metabolite levels in red blood cells as well as by patients' self-report using standardized questionnaire. RESULTS: Sixty-five patients were prospectively included. Six patients (9.2%) had metabolite profiles indicative of non-adherence. Self-assessed questionnaire revealed non-adherence in four of 56 patients (7.1%). Therapeutic drug monitoring (TDM) and self-assessment as two independent methods had a concordance rate of 75%. Metabolite levels and self-assessed adherence were not significantly different between patients in remission compared with those with active disease. CONCLUSIONS: Out-patients with CD treated in a single gastroenterology practice had a satisfactory adherence (>90%) to thiopurine therapy. Different measures of adherence (TDM and self-report) applied to the same patient suggest comparable levels. TDM appears to be a reliable tool to assess adherence to thiopurines in clinical practice.
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