title: Thiopurines and inflammatory bowel disease: Current evidence and a historical perspective.
abstract: The use of thiopurines in inflammatory bowel disease (IBD) has been examined in numerous prospective, controlled trials, with a majority demonstrating a clinical benefit. We conducted this review to describe the historical and current evidence in the use of thiopurines in IBD. A systematic search was performed on MEDLINE between 1965 and 2016 to identify studies on thiopurines in IBD. The most robust evidence for thiopurines in IBD includes induction of remission in combination with anti-tumor necrosis factor (anti-TNF) agents, and maintenance of remission and post-operative maintenance in Crohn's disease. Less evidence exists for thiopurine monotherapy in induction of remission, maintenance of ulcerative colitis, chemoprevention of colorectal cancer, and in preventing immunogenicity to anti-TNF. Evidence was often limited by trial design. Overall, thiopurines have demonstrated efficacy in a broad range of presentations of IBD. With more efficacious novel therapeutic agents, the positioning of thiopurines in the management of IBD will change and future studies will analyze the benefit of thiopurines alone and in conjunction with these new medications.
authors.affiliation: Jordan E Axelrad, Garrett Lawlor, Simon Lichtiger, Department of Medicine, Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY 10032, United States.
authors.forename: Jordan E
authors.initials: JE
authors.lastname: Axelrad
authors.affiliation: Jordan E Axelrad, Garrett Lawlor, Simon Lichtiger, Department of Medicine, Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY 10032, United States.
authors.forename: Abhik
authors.initials: A
authors.lastname: Roy
authors.affiliation: Jordan E Axelrad, Garrett Lawlor, Simon Lichtiger, Department of Medicine, Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY 10032, United States.
authors.forename: Garrett
authors.initials: G
authors.lastname: Lawlor
authors.affiliation: Jordan E Axelrad, Garrett Lawlor, Simon Lichtiger, Department of Medicine, Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY 10032, United States.
authors.forename: Burton
authors.initials: B
authors.lastname: Korelitz
authors.affiliation: Jordan E Axelrad, Garrett Lawlor, Simon Lichtiger, Department of Medicine, Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY 10032, United States.
authors.forename: Simon
authors.initials: S
authors.lastname: Lichtiger
mesh_terms: D001379:Azathioprine / Q000266:history / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D003424:Crohn Disease / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D007166:Immunosuppressive Agents / Q000266:history / Q000627:therapeutic use*; D000069285:Infliximab / Q000627:therapeutic use; D060046:Maintenance Chemotherapy; D015122:Mercaptopurine / Q000266:history / Q000627:therapeutic use*; D012074:Remission Induction; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D005765:Gastrointestinal Agents; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D015122:Mercaptopurine; D001379:Azathioprine
keywords: Azathioprine; Crohn’s disease; Inflammatory bowel disease; Mercaptopurine; Thiopurines; Ulcerative colitis