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Monitoring for drug side‐effects in inflammatory bowel disease

The side‐effects suitable for monitoring in patients with inflammatory bowel disease being treated with the four main groups of drugs (5‐aminosalicylic acid preparations, azathioprine and 6‐mercaptopurine, methotrexate, and corticosteroids) are reviewed. On the basis of the reported frequency, severity and timing of side‐effects, a practical scheme of monitoring is recommended. This includes a baseline measurement of full blood count, creatinine and liver function tests in all patients. In the absence of worrying symptoms, we recommend the following: (i) no monitoring for sulfasalazine; (ii) for other 5‐aminosalicylic acid preparations, the meas‐ urement of creatinine at 6 and 12 months and then annually; (iii) for azathioprine/6‐mercaptopurine, thiopurine methyltransferase genotype/phenotype determination has no role in treatment monitoring, but a full blood count at 2 weeks, 1 month, 3 months and then every 3 months should be performed; (iv) for methotrexate, a full blood count and liver function tests should be performed every 3 months; (v) for steroids, dual energy X‐ray absorptiometry bone scanning should be performed at the start of therapy, every year in which steroids are used if the T score is < 0, and every 3–5 years if the T score is > 0.