Thiopurine Optimization Through Combination With Allopurinol in Children With Inflammatory Bowel Diseases

Objectives: Thiopurines are commonly used in the maintenance of remission for children with inflammatory bowel diseases (IBD). Variation in drug metabolism may impact hepatotoxicity or therapeutic effect. We aimed to describe our center's experience with thiopurine optimization through the use of reduced thiopurine dosing in combination with allopurinol upon hepatotoxicity, drug metabolite levels and clinical outcomes in children with IBD. Methods: Patients aged 2–21 years with IBD treated with the combination of thiopurines/allopurinol between 2008–2015 were retrospectively reviewed. Patients previously treated with anti-tumor necrosis factor (TNF) therapy were excluded. Demographic data, transaminase levels (AST, ALT), drug metabolites levels (6-TG, 6-MMP), physician global assessment (PGA), and corticosteroid use were recorded at baseline, 6 and 12 months. Results: Fifty-two patients (29 female, 56%) met inclusion criteria. Thirty-two of 52 (62%) remained on the combination for 12 months. In those remaining on the thiopurine/allopurinol combination, median ALT and AST levels were reduced (p 

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