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Thiopurine therapy: when to start and when to stop
Dermot P B McGovern1, Simon P L Travis
1Wellcome Trust Centre for Human Genetics and Linacre College, University of Oxford, Oxford, UK.
European Journal of Gastroenterology & Hepatology
|March 1, 2003
Summary
Azathioprine and 6-mercaptopurine are effective for managing active inflammatory bowel disease and maintaining remission. This review details when to initiate thiopurine therapy and its long-term benefits.
Area of Science:
- Gastroenterology
- Clinical Pharmacology
Background:
- Thiopurines, including azathioprine and 6-mercaptopurine, are established treatments for inflammatory bowel disease (IBD).
- Effective management of Crohn's disease and ulcerative colitis often requires long-term therapeutic strategies.
Purpose of the Study:
- To review the efficacy of thiopurines for active IBD and remission maintenance.
- To outline criteria for initiating thiopurine therapy and discuss its benefits up to 5 years.
- To address challenging clinical issues related to thiopurine use.
Main Methods:
- This is a review article, synthesizing existing literature on thiopurine use in IBD.
- Criteria for initiating therapy are presented based on steroid dependency and relapse rates.
- Discussion includes management of intolerance, drug comparisons, monitoring, and use in pregnancy.
Main Results:
- Thiopurines demonstrate efficacy in both active Crohn's disease and ulcerative colitis, as well as in maintaining remission.
- Specific criteria for starting thiopurine treatment are defined, including frequent steroid use or early relapse.
- Continuing thiopurine therapy for up to 5 years is associated with sustained benefits.
Conclusions:
- Thiopurines are valuable agents for IBD management, offering both disease control and remission maintenance.
- Careful patient selection and monitoring are essential for optimizing thiopurine therapy.
- The review provides guidance on complex aspects of thiopurine treatment in IBD patients.