Azathioprine: State of the Art in Inflammatory Bowel Disease

Wj, Sandborn

doi:10.1080/003655298750027290

Cited by 124 publications

(77 citation statements)

References 28 publications

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“…If Group1 UC 7 1 2 4 ---Group1 CD 2 -2 ----Group2 CD 8 3 2 2 1 8 16 Group3 UC 8 1 -7 1 Group3 CD 4 -3 the patient proves to be steroid resistant, or dependent, i m mu n o s u p p r e s s ive t r e a t m e n t i s s u g g e s t e d [ 9 ] . Azathioprine is recommended first, where it is the most frequently used immunosuppressive drug for IBD [10] . An oral dose of 1.5-2.5 mg/kg per day is usually effective, but requires monitoring [11] .…”

Section: Discussionmentioning

confidence: 99%

Efficacy of 6-mercaptopurine treatment after azathioprine hypersensitivity in inflammatory bowel disease

Nagy¹,

Molnár²,

Szepes³

et al. 2008

WJG

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AIM:To investigate the efficacy of 6-mercaptopurine (6-MP) in cases of azathioprine (AZA) hypersensitivity in patients with inflammatory bowel disease. METHODS: Twenty nine previously confirmed Crohn's disease (CD) (n = 14) and ulcerative colitis (UC) (n = 15) patients with a known previous (AZA) hypersensitivity reaction were studied prospectively. The 6-MP doses were gradually increased from 0.5 up to 1.0-1.5 mg/kg per day. Clinical activity indices (CDAI/ CAI), laboratory variables and daily doses of oral 5-ASA, corticosteroids, and 6-MP were assessed before and in the first, sixth and twelfth months of treatment. RESULTS: In 9 patients, 6-MP was withdrawn in the first 2 wk due to an early hypersensitivity reaction. Medication was ineffective within 6 mo in 6 CD patients, and myelotoxic reaction was observed in two. Data were evaluated at the end of the sixth month in 12 (8 UC, 4 CD) patients, and after the first year in 9 (6 UC, 3 CD) patients. CDAI decreased transiently at the end of the sixth month, but no significant changes were observed in the CDAI or the CAI values at the end of the year. Leukocyte counts (P = 0.01), CRP (P = 0.02), and serum iron (P = 0.05) values indicated decreased inflammatory reactions, especially in the UC patients at the end of the year, making the possibility to taper oral steroid doses. CONCLUSION: About one-third of the previously AZAintolerant patients showed adverse effects on taking 6MP. In our series, 20 patients tolerated 6MP, but it was ineffective in 8 CD cases, and valuable mainly in ulcerative colitis patients.

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Section: Discussionmentioning

confidence: 99%

Efficacy of 6-mercaptopurine treatment after azathioprine hypersensitivity in inflammatory bowel disease

Nagy¹,

Molnár²,

Szepes³

et al. 2008

WJG

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“…Among 21 of them, remission was achieved without corticosteroids or infliximab during the follow-up period (median duration 7 months, range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. The probability of remission without corticosteroids or infliximab was 46% (95% CI, 37-55%) and 79% (95% CI, 70-88%) at 6 and 12 months, respectively ( Figure 2).…”

Section: Efficacymentioning

confidence: 99%

Tioguanine in patients with Crohn's disease intolerant or resistant to azathioprine/mercaptopurine

Bonaz

Boitard

Marteau

et al. 2003

Aliment Pharmacol Ther

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Summary Background: Tioguanine (TG) is an antimetabolite which may be regarded as an alternative to azathioprine (AZA)/mercaptopurine (MP) in patients with inflammatory bowel diseases. Aims : To evaluate the tolerance and efficacy of TG in patients with Crohn's disease, intolerant or resistant to AZA/MP. Methods : An open prospective study was made on Crohn's disease patients treated with TG. Intolerance to AZA/MP was defined as a reaction occurring within 1 month after introduction of AZA/MP, including pancreatitis, abdominal pain, fever, arthralgia, myalgia, cutaneous rash, fatigue, alopecia, hepatitis and digestive intolerance. Resistance to AZA/MP was defined as the persistence of activity after at least 3 months of AZA/MP therapy. Results : Forty‐nine Crohn's disease patients (36 women, 13 men; intolerance: n = 39; resistance: n= 10) were treated with TG (20 mg/day). Clinical pancreatitis did not recur under TG. Five patients (10%) had to stop TG due to intolerant reactions observed 13–21 days after TG was started. No haematological side‐effects were observed under TG. The probability of clinical remission without corticosteroids or infliximab at 6 and 12 months was 46% and 79%, respectively, in the 40 patients with active disease at baseline. The probability of clinical relapse during maintenance TG therapy at 6 and 12 months was 29% and 53%, respectively, in the 28 patients in remission at baseline or who had achieved remission on TG. Conclusions : TG is a possible alternative treatment in Crohn's disease patients, intolerant (especially for pancreatitis) or resistant to AZA/MP.

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“…65 Purine analogues Azathioprine and 6mercaptopurine are both purine analogues and widely used immunesuppressants to dampen the immune response in both conditions. 66 Similarly to 5ASAs, these medications can cause an acute leucopenia which can severely impair the body's effect on fighting infection. 67 Secondly, there is a fourfold documented increase in the risk of lymphoma with these medications which can present in the oral cavity.…”

Section: -Asasmentioning

confidence: 99%

Inflammatory bowel disease and oral health

Chandan

Thomas

2017

BDJ Team

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Risk factors involved in IBDIBD is thought to result from inappropriate and ongoing activation of the mucosal immune system facilitated by defects in both the intestinal epithelium and mucosal immune system. 5 There are both genetic and environmental factors implicated in the aetiology of IBD. 6 Although traditionally associated with the developed world, recent epidemiological studies suggest an increasing incidence in rapidly developing countries, especially in South-East Asia. 7 In addition, the increased risk of IBD in the immigrant populations in the West suggests environment has a role in the development of IBD. 8 Genetic Detailed genetic mapping has identified specific genetic changes on chromosome 16 carried in families which appear linked to CD, however no significant changes have been mapped as of yet to UC. 9,10 Specifically, variants of the NOD2 gene provide the strongest association with susceptibility to CD. NOD2 plays a key role in regulating the gut mucosal barrier involving, specifically, the microbiota, as well as the related response by the innate and adaptive immune system. The IBDchip European Project showed NOD2 has been implicated in ileal location colitis with stenosing and penetrating disease behaviour. 11 A genome wide association study has also identified a strong link between the IL23R gene and CD. 12 The gene in particular codes for interleukin 23 that plays a role in regulating innate immunity within the intestine. 13 Cigarette smoking Unusually, cigarette smoking is associated with decreased rates of incidence of UC and has been associated with protective features to prevent further flare-ups of the condition 14-19 such as relapses, 20 ©SEBASTIAN KAULITZKI/Science Photo Library/Getty J. S. Chandan 1 and T. Thomas 1 summarise the treatments for inflammatory bowel disease (IBD) and how anti-inflammatory medications can have side effects that affect the oral cavity.

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Azathioprine: State of the Art in Inflammatory Bowel Disease

Cited by 124 publications

References 28 publications

Efficacy of 6-mercaptopurine treatment after azathioprine hypersensitivity in inflammatory bowel disease

Efficacy of 6-mercaptopurine treatment after azathioprine hypersensitivity in inflammatory bowel disease

Tioguanine in patients with Crohn's disease intolerant or resistant to azathioprine/mercaptopurine

Inflammatory bowel disease and oral health

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