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

Gabriele Stocco, Margherita Londero, Angelo Campanozzi, Stefano Martelossi, Sara Marino, Noelia Malusa, Fiora Bartoli, Giuliana Decorti, Alessandro Ventura

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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.

Original languageEnglish
Pages (from-to)599-602
Number of pages4
JournalJournal of Crohn's & colitis
Issue number5
Publication statusPublished - Nov 2010


  • Adherence
  • Autoimmune hepatitis
  • Azathioprine
  • Inflammatory bowel disease
  • Metabolites

ASJC Scopus subject areas

  • Gastroenterology


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