Thiopurines in Crohn's disease, is there something new?

Research output: Contribution to journalReview article

9 Citations (Scopus)

Abstract

Importance of the field: Traditional immunosuppressants, including azathioprine, remain the mainstay of therapy in steroid dependent/refractory patients with inflammatory bowel diseases (IBD). The main limitations of its use are its side effects appearing in about a fifth of the patients, including myelosuppression and liver toxicity. Major complications occur in patients with low thiopurine-S-methyltransferase (TPMT) enzyme activity; however, the clinical relevance of these tests remains conflictive. Areas covered in this review: In this review, the authors aim to summarize the new data regarding the relationship between the pharmacology of thiopurines and pathogenesis of adverse events. What the reader will gain: Readers will gain an understanding of the metabolism of thiopurines, side effect profile, pharmacological background of side effects, importance of metabolite monitoring, clinical relevance of inherited differences in drug metabolism and other conditions (e.g., concomitant use of allopurinol) which can modify enzyme activity. By gaining an understanding of the pharmacology and metabolism of thiopurines, clinicians will be able to optimize thiopurine therapy in IBD. Take home message: TPMT testing and metabolite monitoring are still not considered the standard of care, and clinicians will continue to choose the approach that best suits their clinical practice and patient needs. Regardless of what strategy is chosen, patients need to be carefully monitored and well informed about the potential risks.

Original languageEnglish
Pages (from-to)1505-1514
Number of pages10
JournalExpert Opinion on Drug Metabolism and Toxicology
Volume6
Issue number12
DOIs
Publication statusPublished - Dec 1 2010

Keywords

  • Azathioprine
  • Crohn's disease
  • Inflammatory bowel disease
  • Pharmacology
  • TMPT

ASJC Scopus subject areas

  • Toxicology
  • Pharmacology

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