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název v anglickém jazyce není uveden
Koubíková, Petra ; Lukáš, Milan (advisor) ; Zbořil, Vladimír (referee) ; Konečný, Michal (referee)
Background: Thioguanine derivatives, azathioprine (AZA) and 6-mercaptopurine (6-MP), have been used for many years in the treatment of inflammatory bowel disease (IBD). They represent major drugs in therapy of steroid-dependent and chronic active IBD. In 20-35% of the patients administration of AZA or 6-MP does not lead to improvement of the disease. Another limitation is the occurrence of adverse events of the therapy which can be observed in 10-15% of the patients. The metabolism of AZA/6-MP is influenced by thiopurine methyl transferase (TPMT). Since there is a significant variability in the activity of TPMP, there is an idea that monitoring the enzyme activity or the genotyping can significantly minimize the toxicity. Several studies have analysed correlation between the levels of AZA/6-MP and the efficacy or toxicity. The cut-off level corresponds to 230-250 pmol/8x108 RBC. High concentrations are linked with a risk of myelotoxicity. The occurrence of hepatotoxicity is dependent on the concentration of 6-methylmercaptopurine (6-MMP) in the erythrocytes. 6-thioguanine (6-TG) has been studied as an alternative therapy in patients with inflammatory bowel disease, who are resistant or intolerant to AZA/6-MP.The administration of 6-TG is effective in approximately 60% of patients. However, 6-TG...
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Adherence to pharmacotherapy by idiopathic inflammatory bowel diseases
Červený, Petr ; Vlček, Jiří (advisor) ; Fendrich, Zdeněk (referee) ; Zbořil, Vladimír (referee)
Aim of the work The aim of the work was to analyze patient's adherence (compliance) to the pharmacotherapy of inflammatory bowel disease in Czech Republic, as well as to analyze quantity and character of potential drug interactions in medications of the tested kohort. Our aims were : 1. to analyze adherence to pharmacotherapy of IBD: o in the patients cohort followed up in the single IBD Unit (Gastroenterological Centre, the 4th Medical Department, Prague) o in the patients cohort followed up in a few gastroenterological ambulancies in the Czech Republic 2. to analyze potential drug interactions in medications of IBD patients Results 1. Adherence to pharmacotherapy of IBD in the patients cohort followed up in the single IBD Unit (Gastroenterological Centre of the 4th Medical department, Prague) 177 patients were enrolled in the study (84 male, 93 female, 117 CD, 60 UC). The patients evaluated their adherence to the pharmacological treatment in an interview. From 47 patients, treated by mesalazine, the urine sample for HPLC analysis of mesalazine was taken. The data was processed by descriptive statistics and factor analysis. 18.6 % of patients admitted they minimally once in the past voluntarily discontinuated their treatment, without their gastroenterologist's consent. A voluntary lowering of the...
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název v anglickém jazyce není uveden
Koubíková, Petra ; Lukáš, Milan (advisor) ; Zbořil, Vladimír (referee) ; Konečný, Michal (referee)
Background: Thioguanine derivatives, azathioprine (AZA) and 6-mercaptopurine (6-MP), have been used for many years in the treatment of inflammatory bowel disease (IBD). They represent major drugs in therapy of steroid-dependent and chronic active IBD. In 20-35% of the patients administration of AZA or 6-MP does not lead to improvement of the disease. Another limitation is the occurrence of adverse events of the therapy which can be observed in 10-15% of the patients. The metabolism of AZA/6-MP is influenced by thiopurine methyl transferase (TPMT). Since there is a significant variability in the activity of TPMP, there is an idea that monitoring the enzyme activity or the genotyping can significantly minimize the toxicity. Several studies have analysed correlation between the levels of AZA/6-MP and the efficacy or toxicity. The cut-off level corresponds to 230-250 pmol/8x108 RBC. High concentrations are linked with a risk of myelotoxicity. The occurrence of hepatotoxicity is dependent on the concentration of 6-methylmercaptopurine (6-MMP) in the erythrocytes. 6-thioguanine (6-TG) has been studied as an alternative therapy in patients with inflammatory bowel disease, who are resistant or intolerant to AZA/6-MP.The administration of 6-TG is effective in approximately 60% of patients. However, 6-TG...
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