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Do children with IBD really respond better than adults to thiopurines?

J R Goodhand1, N Tshuma, A Rao

  • 1Digestive Diseases Clinical Academic Unit, Barts, and the London School of Medicine and Dentistry, Queen Mary's University, London, UK.

Journal of Pediatric Gastroenterology and Nutrition
|May 20, 2011
PubMed

Insights

Thiopurines are better tolerated in children with inflammatory bowel disease (IBD). When matched for disease type and extent, children and adults show similar therapeutic responses to thiopurines.

Area of Science:

  • Pediatric Gastroenterology
  • Immunosuppressive Therapy
  • Inflammatory Bowel Disease (IBD)

Background:

  • Pediatric inflammatory bowel disease (IBD) often presents with more severe and extensive disease compared to adult-onset IBD.
  • Thiopurines are commonly used for IBD treatment, with a perception of greater efficacy in pediatric populations, despite limited comparative evidence.

Purpose of the Study:

  • To compare the efficacy and tolerance of thiopurine therapy in pediatric and adult patients with IBD.
  • To investigate whether perceived higher efficacy of thiopurines in children is supported by evidence when disease phenotype is matched.

Main Methods:

  • A retrospective study matched 50 pediatric and 50 adult IBD patients initiating thiopurine therapy based on sex, disease type, and extent.
  • Data collected included corticosteroid-free clinical remission at 6 months, tolerance rates, and subsequent 1-year relapse rates.

Main Results:

  • Thiopurines were significantly better tolerated in children, with only 1/50 discontinuing due to adverse effects compared to 16% (8/50) of adults (P < 0.05).
  • At 6 months, steroid-free remission rates were similar: 30% (15/50) in children and 38% (19/50) in adults (P = 0.53).
  • Remission was sustained in 73% of children and 68% of adults at the end of the following year, with no significant difference observed.

Conclusions:

  • Children with IBD demonstrate superior tolerance to thiopurine medications compared to adults.
  • When matched for disease phenotype, thiopurine therapy yields comparable therapeutic responses in pediatric and adult patients with IBD.
Abstract

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