The Evolving Role of Thiopurines in Inflammatory Bowel Disease.

Curr Treat Options Gastroenterol 2019 Dec;17(4):435-448

Northwestern University, Chicago, IL, USA.

Purpose Of Review: With the advent of biologic therapies for the treatment of IBD, the roles of thiopurines have continued to evolve. This review will focus on recent advances in pharmacology and the safety and efficacy of thiopurines as maintenance therapies for steroid-induced remissions, post-surgical maintenance of remission, and as combination therapies to reduce immunogenicities of biologic agents.

Recent Findings: Due to pharmacogenetics of TPMT, thiopurine dosing is more effectively based on monitoring of thiopurine metabolites rather than weight-based dosing. Thiopurines continue to have a role as maintenance therapy after steroid-induced remissions and in combination with biologics to induce and maintain remission. Safety monitoring includes measurements of blood counts, liver chemistries, as well as dermatologic evaluations and protection from sun exposure. Thiopurines appear to be safe during pregnancies and while very uncommon, lymphomas (including hepatosplenic T cell lymphomas) remain a recognized risk, particularly in younger and older males.

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http://dx.doi.org/10.1007/s11938-019-00249-yDOI Listing
December 2019

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References

(Supplied by CrossRef)

U Hindorf et al.
Gut 2006

BI Eklund et al.
Mol Pharmacol 2006

J Amin et al.
Inflamm Bowel Dis 2015

RM Weinshilboum et al.
Am J Hum Genet 1980

MC Dubinsky et al.
Gastroenterology 2003

LJ Derijks et al.
Ther Drug Monit 2004

SJ Gardiner et al.
Clin Gastroenterol Hepatol 2008

GJ Walker et al.
JAMA 2019

C Cuffari et al.
Clin Gastroenterol Hepatol 2004

T Dassopoulos et al.
Aliment Pharmacol Ther 2014

AJ Yarur et al.
J Clin Gastroenterol 2018

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