Toxicity and response to thiopurines in patients with inflammatory bowel disease.
The use of thiopurines is well established in the management of inflammatory bowel disease. A wealth of data and experience, amassed over several decades, supporting their efficacy has recently been challenged by trials that failed to show a benefit in Crohn's disease when used early in the disease course, although other trials continue to support their role both as monotherapy and in combination with anti-TNF. Recent reports of previously unrecognized toxicity have also emerged. Fortunately, the absolute incidence of serious toxicity remains low, and an improved understanding of how best to minimize risk and the recognition of groups of patients at higher risk of toxicity from thiopurines means that they remain a relatively safe therapy in the majority of patients. In this paper, we review the literature evaluating the role of thiopurines in inflammatory bowel disease as well as their toxicity. We conclude that education regarding the spectrum of thiopurine side effects and optimal monitoring during therapy may help with optimizing safety and efficacy of these important medications.
Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Rimma
R
Goldberg
Peter M
PM
Irving
D001379:Azathioprine / Q000009:adverse effects* / Q000627:therapeutic use; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D003424:Crohn Disease / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015122:Mercaptopurine / Q000009:adverse effects; D009325:Nausea / Q000139:chemically induced; D009369:Neoplasms / Q000139:chemically induced*; D009503:Neutropenia / Q000139:chemically induced; D009894:Opportunistic Infections / Q000139:chemically induced; D010195:Pancreatitis / Q000139:chemically induced
D007166:Immunosuppressive Agents; D015122:Mercaptopurine; D001379:Azathioprine
IBD; azathioprine; mercaptopurine; thiopurine