Use of thiopurines in inflammatory bowel disease

被引:23
作者
Frei, Pascal [1 ]
Biedermann, Luc [1 ]
Nielsen, Ole Haagen [2 ]
Rogler, Gerhard [1 ]
机构
[1] Univ Zurich Hosp, Dept Internal Med, Div Gastroenterol & Hepatol, CH-8091 Zurich, Switzerland
[2] Univ Copenhagen, Herlev Hosp, Dept Gastroenterol, Med Sect, DK-2730 Herlev, Denmark
关键词
Thiopurines; Inflammatory bowel disease; Crohn's disease; Ulcerative colitis; Immunosuppression; Infection; NODULAR REGENERATIVE HYPERPLASIA; 6-THIOGUANINE NUCLEOTIDE CONCENTRATIONS; AZATHIOPRINE-INTOLERANT PATIENTS; S-METHYLTRANSFERASE ACTIVITY; NONMELANOMA SKIN-CANCER; LOW-DOSE; 6-THIOGUANINE; CROHNS-DISEASE; DOUBLE-BLIND; LONG-TERM; CONTROLLED-TRIAL;
D O I
10.3748/wjg.v19.i7.1040
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
The use of thiopurines as immunosuppression for the treatment of refractory or chronic active inflammatory bowel disease is established for both Crohn's disease and ulcerative colitis. Nevertheless, many questions remain concerning the optimal treatment regimens of azathioprine, 6-mercaptopurine and thioguanine. We will briefly summarize dose recommendations, indications for thiopurine therapy and side effects which are relevant in clinical practice. We discuss some currently debated topics, including the combination of azathioprine and allopurinol, switching of thiopurine therapy in case of side effects, the use of azathioprine in pregnancy, the infection risk using thiopurines and the evidence when to stop thiopurines. Excellent reviews have been published on the thiopurine metabolic pathway which will not be discussed here in detail. (C) 2013 Baishideng. All rights reserved.
引用
收藏
页码:1040 / 1048
页数:9
相关论文
共 99 条
[1]   Monitoring 6-thioguanine nucleotide concentrations in Japanese patients with inflammatory bowel disease [J].
Andoh, Akira ;
Tsujikawa, Tomoyuki ;
Ban, Hiromitsu ;
Hashimoto, Takayoshi ;
Bamba, Shigeki ;
Ogawa, Atsuhiro ;
Sasaki, Masaya ;
Saito, Yasuharu ;
Fujiyama, Yoshihide .
JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, 2008, 23 (09) :1373-1377
[2]   Low-dose azathioprine or mercaptopurine in combination with allopurinol can bypass many adverse drug reactions in patients with inflammatory bowel disease [J].
Ansari, A. ;
Patel, N. ;
Sanderson, J. ;
O'Donohue, J. ;
Duley, J. A. ;
Florin, T. H. J. .
ALIMENTARY PHARMACOLOGY & THERAPEUTICS, 2010, 31 (06) :640-647
[3]   Risk of Cancer in Inflammatory Bowel Disease Treated With Azathioprine: A UK Population-Based Case-Control Study [J].
Armstrong, Richard G. ;
West, Joe ;
Card, Timothy R. .
AMERICAN JOURNAL OF GASTROENTEROLOGY, 2010, 105 (07) :1604-1609
[4]   STEADY-STATE KINETICS OF 5-AMINOSALICYLIC ACID AND SULFAPYRIDINE DURING SULFASALAZINE PROPHYLAXIS IN ULCERATIVE-COLITIS [J].
BONDESEN, S ;
NIELSEN, OH ;
SCHOU, JB ;
JENSEN, PH ;
LASSEN, LB ;
BINDER, V ;
KRASILNIKOFF, PA ;
DANO, P ;
HANSEN, SH ;
RASMUSSEN, SN ;
HVIDBERG, EF .
SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY, 1986, 21 (06) :693-700
[5]   Assessment of Thiopurine S-Methyltransferase Activity in Patients Prescribed Thiopurines: A Systematic Review [J].
Booth, Ronald A. ;
Ansari, Mohammed T. ;
Loit, Evelin ;
Tricco, Andrea C. ;
Weeks, Laura ;
Doucette, Steve ;
Skidmore, Becky ;
Sears, Margaret ;
Sy, Richmond ;
Karsh, Jacob .
ANNALS OF INTERNAL MEDICINE, 2011, 154 (12) :814-823
[6]   Optimizing 6-mercaptopurine and azathioprine therapy in the management of inflammatory bowel disease [J].
Bradford, Kara ;
Shih, David Q. .
WORLD JOURNAL OF GASTROENTEROLOGY, 2011, 17 (37) :4166-4173
[7]   A CONTROLLED DOUBLE-BLIND-STUDY OF AZATHIOPRINE IN THE MANAGEMENT OF CROHNS-DISEASE [J].
CANDY, S ;
WRIGHT, J ;
GERBER, M ;
ADAMS, G ;
GERIG, M ;
GOODMAN, R .
GUT, 1995, 37 (05) :674-678
[8]   Maintenance Treatment With Azathioprine in Ulcerative Colitis: Outcome and Predictive Factors After Drug Withdrawal [J].
Cassinotti, Andrea ;
Actis, Giovanni C. ;
Duca, Piergiorgio ;
Massari, Alessandro ;
Colombo, Elisabetta ;
Gai, Elisa ;
Annese, Vito ;
Albasio, Giuseppe D' ;
Manes, Gianpiero ;
Travis, Simon ;
Porro, Gabriele Bianchi ;
Ardizzone, Sandro .
AMERICAN JOURNAL OF GASTROENTEROLOGY, 2009, 104 (11) :2760-2767
[9]   LOW-DOSE ALLOPURINOL PLUS AZATHIOPRINE CYCLOSPORINE PREDNISOLONE, A NOVEL IMMUNOSUPPRESSIVE REGIMEN [J].
CHOCAIR, P ;
DULEY, J ;
SIMMONDS, HA ;
CAMERON, JS ;
IANHEZ, L ;
ARAP, S ;
SABBAGA, E .
LANCET, 1993, 342 (8863) :83-84
[10]   Review article: the benefits of pharmacogenetics for improving thiopurine therapy in inflammatory bowel disease [J].
Chouchana, L. ;
Narjoz, C. ;
Beaune, P. ;
Loriot, M-A ;
Roblin, X. .
ALIMENTARY PHARMACOLOGY & THERAPEUTICS, 2012, 35 (01) :15-36