[Azathioprine toxicity in Crohn's disease: incidence, approach and course]. / Toxicidade da azatioprina na doença de Crohn: incidência, abordagem e evolução.

OBJECTIVE: Azathioprine (AZA) is frequently used in Crohn's disease (CD) therapy. This paper aimed to evaluate the frequency, evolution and management of AZA side effects in CD patients. METHODS: One hundred and six CD patients under AZA therapy were evaluated prospectively from January 2002 to December 2006. Clinical and demographic data were recorded, together with a monthly laboratory control of hematological or other adverse reactions by means of clinical evaluation. Comparison was carried out between groups with and without side effects. RESULTS: At least one adverse reaction was found in 56 (52.7%) of the patients studied and required a transient drug reduction; 18 (17%) had to definitely stop use of AZA, often because of hypersensitivity reactions. Nausea, vomit, although slight, occurred in 29 (27.4%). The black race and those with co-morbidities had more gastric intolerance than Caucasians and those without other associated disease (p=0.04). Leucopoenia was the more frequent side effect observed, occurring in 36 (34%). The period of AZA use was longer for patients with leucopoenia than for those without (p=0.001), while the mean dose of AZA was lower for those with leucopoenia when compared to non-leucopoenics (p=0.005). No serious infections, malignancy or death was noticed as a consequence of AZA use. CONCLUSION: In this study use of AZA in therapy for Crohn's disease disclosed that the drug is satisfactorily safe as long as periodical clinical and laboratory supervision is carried out during treatment.

Toxicidade da azatioprina na doença de Crohn: incidência, abordagem e evolução / Azathioprine toxicity in Crohn's disease: incidence, approach and course

OBJETIVO: A azatioprina (AZA) tem sido usada freqüentemente no tratamento da doença de Crohn (DC). O objetivo do presente estudo foi avaliar a freqüência, evolução e abordagem dos efeitos adversos da AZA no tratamento de pacientes com DC. MÉTODOS: Foram incluídos prospectivamente 106 pacientes portadores de DC em uso de AZA, de janeiro de 2002 a dezembro de 2006. Registraram-se dados clínicos e demográficos, com controle laboratorial mensal dos efeitos hematológicos e supervisão de reações adversas por meio de avaliação clínica. Realizou-se comparação entre os grupos com e sem efeitos adversos. RESULTADOS: Cinqüenta e seis (52,7 por cento) dos pacientes estudados apresentaram pelo menos um efeito adverso, requerendo redução transitória da dose da droga; 18 (17 por cento) necessitaram suspender definitivamente o uso de AZA, geralmente devido a reações de hipersensibilidade. Náuseas e vômitos, freqüentemente leves, ocorreram em 29 (27,4 por cento); a raça negra e aqueles com comorbidades apresentaram mais intolerância gástrica do que os brancos e aqueles sem outras doenças associadas (p=0,04). Leucopenia foi o efeito adverso mais freqüente, ocorrendo em 36 (34 por cento). O tempo de uso de AZA foi maior em pacientes com leucopenia do que nos não leucopênicos (p=0,001), enquanto a dose média de AZA foi menor naqueles com leucopenia comparados aos não leucopênicos (p=0,005). Não houve infecções graves, neoplasias ou óbitos durante o tratamento com AZA. CONCLUSÃO: A AZA mostrou ser uma droga relativamente segura no tratamento da DC, desde que seja mantida supervisão clínica e laboratorial periódica durante todo o tratamento.

OBJECTIVE: Azathioprine (AZA) is frequently used in Crohn's disease (CD) therapy. This paper aimed to evaluate the frequency, evolution and management of AZA side effects in CD patients. METHODS: One hundred and six CD patients under AZA therapy were evaluated prospectively from January 2002 to December 2006. Clinical and demographic data were recorded, together with a monthly laboratory control of hematological or other adverse reactions by means of clinical evaluation. Comparison was carried out between groups with and without side effects. RESULTS: At least one adverse reaction was found in 56 (52.7 percent) of the patients studied and required a transient drug reduction; 18 (17 percent) had to definitely stop use of AZA, often because of hypersensitivity reactions. Nausea, vomit, although slight, occurred in 29 (27.4 percent). The black race and those with co-morbidities had more gastric intolerance than Caucasians and those without other associated disease (p=0.04). Leucopoenia was the more frequent side effect observed, occurring in 36 (34 percent). The period of AZA use was longer for patients with leucopoenia than for those without (p=0.001), while the mean dose of AZA was lower for those with leucopoenia when compared to non-leucopoenics (p=0.005). No serious infections, malignancy or death was noticed as a consequence of AZA use. CONCLUSION: In this study use of AZA in therapy for Crohn's disease disclosed that the drug is satisfactorily safe as long as periodical clinical and laboratory supervision is carried out during treatment.