Meijer B, Mulder CJ, van Bodegraven AA, de Boer NKH. How I treat my inflammatory bowel disease-patients with thiopurines? World J Gastrointest Pharmacol Ther 2016; 7(4): 524-530 [PMID: 27867685 DOI: 10.4292/wjgpt.v7.i4.524]
Corresponding Author of This Article
Nanne KH de Boer, MD, PhD, Department of Gastroenterology and Hepatology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. khn.deboer@vumc.nl
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
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 Gastrointest Pharmacol Ther. Nov 6, 2016; 7(4): 524-530 Published online Nov 6, 2016. doi: 10.4292/wjgpt.v7.i4.524
How I treat my inflammatory bowel disease-patients with thiopurines?
Berrie Meijer, Chris JJ Mulder, Adriaan A van Bodegraven, Nanne K H de Boer
Berrie Meijer, Chris JJ Mulder, Nanne KH de Boer, Department of Gastroenterology and Hepatology, VU University Medical Center, 1007 MB, Amsterdam, The Netherlands
Adriaan A van Bodegraven, Department of Gastroenterology, Geriatrics, Internal and Intensive Care Medicine (Co-MIK), Zuyderland Medical Center, 6130 MB, Sittard-Geleen, The Netherlands
Author contributions: de Boer NKH was the guarantor of the article; Meijer B completed the first draft of the manuscript; Mulder CJJ, van Bodegraven AA and de Boer NKH critically revised the manuscript; Meijer B finalized the article.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open-Access: 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/
Correspondence to: Nanne KH de Boer, MD, PhD, Department of Gastroenterology and Hepatology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. khn.deboer@vumc.nl
Telephone: +31-20-4440613 Fax: +31-20-4440554
Received: July 21, 2016 Peer-review started: July 21, 2016 First decision: September 5, 2016 Revised: September 12, 2016 Accepted: October 5, 2016 Article in press: October 7, 2016 Published online: November 6, 2016
Abstract
Thiopurines are essential drugs to maintain remission in patients with inflammatory bowel disease (IBD). Thiopurines used in IBD are azathioprine (2.0-2.5 mg/kg), mercaptopurine (1.0-1.5 mg/kg) and thioguanine (0.2-0.3 mg/kg). However, mainly due to numerous adverse events associated with thiopurine use, almost 50% of the patients have to discontinue conventional thiopurine treatment. Extensive monitoring and the application of several treatment strategies, such as split-dose administration, co-administration with allopurinol or dose reduction/increase, may increase the chance of successful therapy. With this review, we provide practical information on how thiopurines are initiated and maintained in two thiopurine research centers in The Netherlands. We provide clinical information concerning safety issues, indications and management of therapy that may serve as a guide for the administration of thiopurines in IBD patients in daily practice.
Core tip: Conventional thiopurine therapy with azathioprine and mercaptopurine in inflammatory bowel disease is associated with several adverse events causing cessation of therapy in up to half of the patients. On the contrary, thiopurine therapy is often unnecessarily discontinued. In this practical review, we provide information on how thiopurine therapy is initiated and maintained using periodical laboratory tests and the application of various treatment strategies (including the administration of a third thiopurine; thioguanine), based on the experience in the two expert thiopurine centers in The Netherlands.
