Abstract
Ulcerative colitis (UC) and Crohn's disease (CD) are chronic inflammatory bowel diseases (IBD) of unknown etiology, characterized by repeated relapse and remission. The efficacy of thiopurine in IBD was first reported in the late 1960s. Thiopurines are used to alleviate the symptoms of IBD, especially UC. These drugs have a steroid-sparing potential and are widely used for the purpose of maintaining long-term remission in steroid-dependent cases. Therefore, thiopurines tend to be used long-term, but adverse events that accompany long-term use, such as lymphoproliferative disorders, must be monitored with care. In contrast, thiopurine plays a critical role in controlling the immunogenicity of biologics. Furthermore, although thiopurine is an old drug, new findings, including the prediction of serious adverse events such as severe alopecia and acute advanced leukopenia, by nudix hydrolase 15 gene polymorphism analysis, as well as the possibility of appropriate drug monitoring by detailed analysis of 6-thioguanine nucleotides have been clarified. However, the consequences of thiopurine withdrawal have not been determined and further studies, including randomized controlled trials, are necessary to answer the clinical question regarding the scenarios in which thiopurine withdrawal is possible.
Highlights
Ulcerative colitis (UC) and Crohn’s disease (CD) are chronic inflammatory bowel diseases (IBDs) with unknown etiology, characterized by repeated relapse and remission (Ghouri et al, 2020)
We described the effectiveness, side effects, and challenges of thiopurines in IBD
This review discussed the use of thiopurine drugs during the COVID-19 pandemic
Summary
Ulcerative colitis (UC) and Crohn’s disease (CD) are chronic inflammatory bowel diseases (IBDs) with unknown etiology, characterized by repeated relapse and remission (Ghouri et al, 2020). In cases where it is difficult to maintain remission with 5-ASA monotherapy, immunomodulators (IMs) are used to attain long-term steroid-free remission after initial induction of remission with steroids (Takahashi et al, 2016; Timmer et al, 2016; Matsuoka et al, 2018). IMs are important for the treatment of CD, where they are used to maintain long-term steroid-free remission and prevent postoperative recurrence (Takahashi et al, 2016; Timmer et al, 2016; Kakuta et al, 2018a; Matsuoka et al, 2018; Gjuladin-Hellon et al, 2019). The efficacies of IMs such as azathioprine (AZA), 6-mercaptopurine (6-MP), Thiopurines in Treatment of IBD. We discuss the positioning of thiopurines in the treatment of IBD, as well as the benefits and risks of thiopurine treatment
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