Frei P, Biedermann L, Nielsen OH, Rogler G. Use of thiopurines in inflammatory bowel disease. World J Gastroenterol 2013; 19(7): 1040-1048 [PMID: 23467510 DOI: 10.3748/wjg.v19.i7.1040]
Corresponding Author of This Article
Gerhard Rogler, MD, PhD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital of Zurich, Raemistrasse 100, CH-8091 Zürich, Switzerland. gerhard.rogler@usz.ch
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Feb 21, 2013; 19(7): 1040-1048 Published online Feb 21, 2013. doi: 10.3748/wjg.v19.i7.1040
Use of thiopurines in inflammatory bowel disease
Pascal Frei, Luc Biedermann, Ole Haagen Nielsen, Gerhard Rogler
Pascal Frei, Luc Biedermann, Gerhard Rogler, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital of Zürich, CH-8091 Zürich, Switzerland
Ole Haagen Nielsen, Department of Gastroenterology, Medical Section, Herlev Hospital, University of Copenhagen, DK-2730 Herlev, Denmark
Author contributions: Frei P wrote the initial draft of the manuscript; Nielsen OH and Rogler G contributed to the conception and design of the review and supervised the review; Biedermann L contributed to the supportive work and revision of the manuscript.
Correspondence to: Gerhard Rogler, MD, PhD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital of Zurich, Raemistrasse 100, CH-8091 Zürich, Switzerland. gerhard.rogler@usz.ch
Telephone: +41-44-2559519 Fax: +41-44-2559497
Received: June 5, 2012 Revised: July 16, 2012 Accepted: August 14, 2012 Published online: February 21, 2013
Abstract
The use of thiopurines as immunosuppression for the treatment of refractory or chronic active inflammatory bowel disease is established for both Crohn's disease and ulcerative colitis. Nevertheless, many questions remain concerning the optimal treatment regimens of azathioprine, 6-mercaptopurine and thioguanine. We will briefly summarize dose recommendations, indications for thiopurine therapy and side effects which are relevant in clinical practice. We discuss some currently debated topics, including the combination of azathioprine and allopurinol, switching of thiopurine therapy in case of side effects, the use of azathioprine in pregnancy, the infection risk using thiopurines and the evidence when to stop thiopurines. Excellent reviews have been published on the thiopurine metabolic pathway which will not be discussed here in detail.
