Usefulness of the measurement of azathioprine metabolites in the assessment of non-adherence

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• 作者：Gabriele Stocco^a ; Margherita Londero^b ; Angelo Campanozzi^c ; Stefano Martelossi^d ; Sara Marino^a ; ^d ; Noelia Malusa^e ; Fiora Bartoli^b ; Giuliana Decorti^a ; ^{decorti@units.it} ; Alessandro Ventura^b
• 关键词：Azathioprine ; Metabolites ; Adherence ; Inflammatory bowel disease ; Autoimmune hepatitis
• 刊名：Journal of Crohn's and Colitis
• 出版年：2010
• 出版时间：November 2010
• 年：2010
• 卷：4
• 期：5
• 页码：599-602
• 全文大小：169 K

文摘

Azathioprine is a thiopurine immunosuppressive antimetabolite used to chronically treat inflammatory bowel disease and autoimmune hepatitis. Azathioprine treatment is a long-term therapy and therefore it is at risk for non-adherence, which is considered an important determinant of treatment inefficacy. Measurement of 6-thioguanine and 6-methylmercaptopurine nucleotides has been recently suggested as a screener for non-adherence detection.

We describe four young patients in which non-adherence to azathioprine therapy was detected only through the measurement of drug metabolite concentrations, and the criterion for non-adherence was undetectable metabolite levels. After the identification of non-adherence, patients and their families were approached and the importance of a correct drug administration was thoroughly enlightened and discussed; this allowed obtaining a full remission in all subjects.

Our observations support the use of undetectable metabolite levels as indicators of non-adherence to therapy in azathioprine treated patients. The additional level of medical supervision given by this assay allows getting a better adherence to medical treatment, which results in an improvement in the response to therapy; these benefits may justify the costs associated with the assay.