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PLoS One. 2016 May 23;11(5):e0155218. doi: 10.1371/journal.pone.0155218. eCollection 2016.

The Impact of Azathioprine-Associated Lymphopenia on the Onset of Opportunistic Infections in Patients with Inflammatory Bowel Disease.

Author information

1
Division of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
2
Division of Gastroenterology and Hepatology, Stadtspital Triemli, Zurich, Switzerland.
3
Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.
4
Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, St. Gallen, Switzerland.

Abstract

BACKGROUND:

Thiopurines are known to cause lymphopenia (<1,500 lymphocytes/μl). As severe lymphopenia (<500C/μl) is associated with opportunistic infections, we investigated severity of thiopurine-related lymphopenia and development of opportunistic infections in our tertiary referral centre.

METHODS:

We retrospectively screened medical records of 1,070 IBD patients and identified 100 individuals that developed a total of 161 episodes of lymphopenia during thiopurine treatment between 2002 and 2014. Occurrence of opportunistic infections was documented. A control group consisted of IBD patients receiving thiopurines but without developing lymphopenia.

RESULTS:

Of a total of 161 episodes of lymphopenia, 23% were severe (<500C/μl). In this subgroup, thiopurine dosing was modified in 64% (dosage reduction: 32%, medication discontinued: 32%). We identified 9 cases (5.5%) of opportunistic infections, of which only two occurred during severe lymphopenia. One opportunistic infection (4.5%) was identified in the control group. No association was found between opportunistic infections and severity of lymphopenia. All patients who suffered from opportunistic infections were receiving additional immunosuppressive medication.

CONCLUSION:

Our patients treated with thiopurines rarely developed severe lymphopenia and opportunistic infections did not occur more often than in the control group. A careful monitoring of lymphocytes and prophylactic adjustment of thiopurine therapy might contribute to this low incidence.

PMID:
27214202
PMCID:
PMC4877071
DOI:
10.1371/journal.pone.0155218
[Indexed for MEDLINE]
Free PMC Article

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