Mercaptopurine treatment should be considered in azathioprine intolerant patients with inflammatory bowel disease

Hindorf, Ulf; Johansson, Mia; Eriksson, Anders; Kvifors, Eva; Almér, Sven

doi:10.1111/j.1365-2036.2008.03925.x

Cited by 101 publications

(84 citation statements)

References 31 publications

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“…A significant number of IBD patients will experience side effects with azathioprine, leading to discontinuation of therapy in up to 60% of patients [69]. Several studies have shown that some azathioprine-intolerant UC patients benefit from a switch to mercaptopurine [70,71]. In case of intolerance to both azathioprine and mercaptopurine, thioguanine can be considered as an alternative maintenance therapy.…”

Section: Thiopurinesmentioning

confidence: 97%

Update on the Management of Ulcerative Colitis

Hoentjen

Sakuraba

Hanauer

2011

Curr Gastroenterol Rep

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The treatment options for inflammatory bowel disease have expanded with the introduction of biological therapies. Recently published controlled clinical trials were searched and those that impact the clinical management of ulcerative colitis (UC) are discussed in this review. In the management of mild to moderate UC, mesalamine still remains the first choice of drug. The newly developed once daily formulations have shown equal efficacy to divided doses and possibly portend better compliance owing to a simplified regimen. In outpatients with moderate to severe UC, recent data indicate that infliximab induced and maintained remission leads to decreased colectomy rates and fewer hospitalizations. An alternative anti-tumor necrosis factor (TNF) agent, adalimumab, was also recently shown to be effective for induction of remission in moderate to severe UC. The use of immunosuppressives, such as azathioprine and mercaptopurine, is associated with decreased colectomy rates and thioguanine was shown to be effective in maintaining clinical remission in those who are intolerant to azathioprine/mercaptopurine. In hospitalized patients with steroid resistant severe UC, infliximab and tacrolimus may be alternatives to cyclosporine in those who are otherwise candidates for colectomy. Adequate long-term maintenance therapy with immunosuppressives or anti-TNF therapy is required after rescue therapy for a sustained benefit. Future research is needed to position the available anti-TNF agents and combined immunosuppressive therapy in the treatment of UC to achieve and maintain steroid free remission.

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Section: Thiopurinesmentioning

confidence: 97%

Update on the Management of Ulcerative Colitis

Hoentjen

Sakuraba

Hanauer

2011

Curr Gastroenterol Rep

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“…Other potential adverse events associated with azathioprine include allergic reactions, rash, fever, headache, fatigue, anorexia, cholestatic hepatitis, and arthralgias. Approximately 50 % of patients who discontinue azathioprine due to adverse events can subsequently tolerate 6-MP, but this should not be prescribed to patients who experienced bone marrow suppression or pancreatitis [ 44 ].…”

Section: Thiopurine Immunosuppressivesmentioning

confidence: 99%

Medical Therapy for Crohn’s Disease: The Present

Fausel

Zisman

2015

Crohn’s Disease

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“…Digestive intolerance might be due to the imidazole compound, liberated by the AZA transformation into 6MP raising the possibility that indeed such side effects could be avoided in 1 ⁄ 2 to 2 ⁄ 3 of cases by switching from AZA to 6MP [63][64][65]. It would be interesting to check, if the GST activity plays a role in the emergence of these side effects.…”

Section: Glutathion-s-transferase (Gst)mentioning

confidence: 99%