World J Gastroenterol 2013 February 21; 19(7): 1040-1048
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
© 2013 Baishideng. All rights reserved.
Use of thiopurines in inflammatory bowel disease
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.
© 2013 Baishideng. All rights reserved.