Azathioprine or 6-mercaptopurine for inflammatory bowel disease: do risks outweigh benefits?
The treatment of Crohn's disease and ulcerative colitis has evolved and has improved the quality of life of patients afflicted with these disorders. Immune modulators such as azathioprine and 6-mercaptopurine are an important class of medications used for the treatment of patients with inflammatory bowel disease. Controlled studies have demonstrated their efficacy in both induction and maintenance of remission in Crohn's disease, and similarly, for the induction and maintenance of remission in patients with ulcerative colitis. These agents have had an increasing importance in the management of steroid-resistant, steroid-dependent diseases, and fistulizing Crohn's disease. The primary limitations to these agents have been their slow onset of action and their side effect profile. Despite these limitations, these agents have demonstrated efficacy and have become paramount to the management of patients with these incurable potentially disabling disorders. The precise role of azathioprine/6-mercaptopurine, their limitations and their safety are reviewed in this paper.
Su
C G
CG
Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia 19104-4283, USA.
Stein
R B
RB
Lewis
J D
JD
Lichtenstein
G R
GR
D001379:Azathioprine / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D004347:Drug Interactions; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000473:pathology; D015122:Mercaptopurine / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D009369:Neoplasms / Q000139:chemically induced; D012307:Risk Factors
D007166:Immunosuppressive Agents; D015122:Mercaptopurine; D001379:Azathioprine