Visser, Thomas (2022) Laboratory investigations in thiopurine therapy, less is more. An evaluation of the effectiveness of standardized laboratory investigations in thiopurine therapy in adult IBD patients. thesis, Medicine.
Full text available on request.Abstract
Introduction and aim: Inflammatory Bowel Disease (IBD) is a systemic disease that causes chronic inflammation of the gastrointestinal tract. The two major subtypes are Crohn’s Disease and Ulcerative Colitis. Thiopurines have been used to treat IBD for decades. Because adverse events may present at any point during thiopurine therapy a standardized blood testing scheme has been suggested. This study aims to determine the effectiveness of frequently performing blood testing in adult IBD patients after the start of thiopurine therapy. Methods: A real-life cohort study was performed in the Medical Center Leeuwarden, an IBD expert center in The Netherlands. Laboratory testing was performed prior to starting thiopurine treatment, then at 1, 2, 4, 8 and 12 weeks and every 3 months thereafter up to one year of follow-up. At each time-point Hemoglobin, thrombocytes, white blood count, liver enzymes and if available drug metabolites were determined. Patients understanding and experiences with this blood testing protocol were investigated by means of a questionnaire. Results: Overall 152 patients were included. Out of the total number of 5791 laboratory tests, 16 abnormal values were associated with thiopurine therapy and resulted in a clinically relevant intervention in 5% of the population. All interventions were either temporary or definitive cessations of thiopurine treatment. Most thiopurine-related laboratory abnormalities occurred in week 2, 4 and at 6 months and were found in patients using either Azathioprine or Mercaptopurine. Costs of laboratory investigations in the first year after starting thiopurine therapy are €195 per patient. The vast majority of patients know the reason for close monitoring, find this to be necessary and are willing to follow the laboratory testing scheme. Conclusion: Frequent laboratory investigations after the start of thiopurine therapy according to the proposed schedule of the Dutch guideline has a low diagnostic clinically relevant yield.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Tack, G. |
| Faculty: | Medical Sciences |
| Date Deposited: | 02 May 2023 13:03 |
| Last Modified: | 02 May 2023 13:03 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3502 |
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