Use of thiopurines in inflammatory bowel disease: an update

Singh, Arshdeep; Mahajan, Ramit; Kedia, Saurabh; Dutta, Amit Kumar; Anand, Abhinav; Bernstein, Çharles N.; Desai, Devendra; Pai, C. Ganesh; Makharia, Govind; Tevethia, Harsh Vardhan; Mak, Joyce Wing Yan; Kaur, Kirandeep; Peddi, Kiran; Ranjan, Mukesh Kumar; Arkkila, Perttu; Kochhar, Rakesh; Banerjee, Rupa; Sinha, Saroj Kant; Ng, Siew C.; Hanauer, Stephen B.; Verma, Suhang; Dutta, Usha; Midha, Vandana; Mehta, Varun; Ahuja, Vineet; Sood, Ajit

doi:10.5217/ir.2020.00155

Cited by 59 publications

(37 citation statements)

References 110 publications

(205 reference statements)

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“…Our meta-analysis results strongly support that an IGRA should be performed prior to initiation of corticosteroids and immunomodulators as well as prior to initiation of TNF-α inhibitors. Given that many IBD patients require corticosteroid treatment at the early stage of diagnosis and maintain remission with immunomodulators [ 44 , 45 ], it is ideal to perform an IGRA at the time of diagnosis of IBD. However, clinicians often encounter cases in which an IGRA is not performed at diagnosis but after IST has already started.…”

Section: Discussionmentioning

confidence: 99%

Impact of Immunosuppressive Therapy on the Performance of Latent Tuberculosis Screening Tests in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Park

Jung

2022

JPM

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Screening for latent tuberculosis infection (LTBI) is mandatory before commencing tumor necrosis factor (TNF)-α inhibitor use. However, the impact of immunosuppressive therapy (IST), including corticosteroids and immunomodulators, on the performance of LTBI screening in patients with inflammatory bowel disease (IBD) has not been fully elucidated. We searched all relevant studies published before November 2021 that examined the performance of interferon γ release assays (IGRAs) and tuberculin skin tests (TSTs) in patients with IBD who received IST, using the Medline, EMBASE, and Cochrane Library databases. We performed meta-analyses of positive or indeterminate rates of IGRA or TST according to IST and calculated the concordance rates between IGRA and TST results. A total of 20 studies with 4045 patients were included in the meta-analysis. The IGRA-positive rate was lower in patients on IST than in those not on IST (odds ratio (OR) (95% confidence interval (CI)) = 0.55 (0.39–0.78)), whereas the IGRA-indeterminate rate was higher in patients on IST than in those not on IST (OR (95% CI) = 2.91 (1.36–6.24)). The TST-positive rate did not differ between the on-IST and not-on-IST groups (OR (95% CI) = 0.87 (0.51–1.50)). The concordance rate between IGRA and TST was 83.3% (95% CI, 78.5–88.1%). The IGRA-negative/TST-positive rate tended to be higher than that the IGRA-positive/TST-negative rate (9.5% vs. 5.8%, respectively), although the difference was not statistically significant. In conclusion, IGRA results were negatively affected by IST in patients with IBD, supporting requirements that IGRA should be performed before initiating IST. The use of both an IGRA and TST in patients with IBD on IST may improve the diagnosis rate of LTBI.

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Section: Discussionmentioning

confidence: 99%

Impact of Immunosuppressive Therapy on the Performance of Latent Tuberculosis Screening Tests in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Park

Jung

2022

JPM

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“… ACE angiotensin converting enzyme, CYP2C19 cytochrome P-450 2Cq19, CYP3A4 cytochrome P-450 3A4, HBV hepatitis B virus, HCV hepatitis C virus, NMSC non-melanoma skin cancer, OAT3 human organic anion transporter 3 (see ref. [ 40 , 51 , 65 – 71 ]), TBC tuberculosis, TNF tumor necrosis factor, URT upper respiratory tract infections, UVA ultraviolet A rays, 6-MP 6-mercaptopurine …”

Section: Therapy-related Risks In Older Patients With Ucmentioning

confidence: 99%

“…In this section, we will focus on risks associated with the disease itself in older UC patients and induced or enhanced by therapies approved for the treatment of UC. With the exception of well-known specific risks of drug categories, such as osteoporosis, fractures, hypertension, and diabetes due to steroids [ 69 , 70 ] or bone marrow and liver toxicity due to immunomodulators [ 71 , 72 ], we will consider infections, in part potentiated by combination therapies, the risk of malignancies, thromboembolism, and mortality. Frequently, these studies have been carried out on older mixed IBD populations but, whenever possible, peculiar aspects in UC patients will be addressed.…”

Section: Therapy-related Risks In Older Patients With Ucmentioning

confidence: 99%

Ulcerative Colitis in Adulthood and in Older Patients: Same Disease, Same Outcome, Same Risks?

et al. 2022

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The number of patients with inflammatory bowel disease (IBD) approaching an older age, together with the number of over-60-year-old patients newly diagnosed with IBD, is steadily increasing, reaching 25% of all patients. The present review focuses on late-onset ulcerative colitis (UC) and its initial disease course in comparison with that observed in younger adults in terms of extension at onset and the risk of proximal disease progression, medical treatment, surgery and hospitalization in the first years after diagnosis. We summarize the clues pointing to a milder disease course in a population which frequently presents major frailty due to comorbidities. With increasing age and thus increasing comorbidities, medical and surgical therapies frequently represent a challenge for treating physicians. The response, persistence, and risks of adverse events of conventional therapies indicated for late onset/older UC patients are examined, emphasizing the risks in this particular population, who are still being treated with prolonged corticosteroid therapy. Finally, we concentrate on data on biotechnological agents for which older patients were mostly excluded from pivotal trials. Real-life data from newer agents such as vedolizumab and ustekinumab show encouraging efficacy and safety profiles in the population of older UC patients.

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“…[1][2][3] For the management of UC, the cornerstones of medi-cal treatment have been 5-aminosalicylic acids (5-ASAs), various forms of corticosteroids, and immunomodulators such as azathioprine and 6-mercaptopurine. [4][5][6][7][8] Since a few decades ago, anti-tumor necrosis factor α (anti-TNF-α) agents have been used to control UC in patients who are refractory to conventional treatments. Many studies have proved the effectiveness and safety of anti-TNF-α agents in managing UC, and thus they have become a valuable treatment option to spare patients from exposure to corticosteroids that are related to serious side effects.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and Safety of Golimumab in Patients with Ulcerative Colitis: A Multicenter, Prospective, Postmarketing Surveillance Study

Park

Kim

et al. 2021

Gut and Liver

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Background/Aims: Golimumab has been used for patients with ulcerative colitis (UC) since 2013. However, there is limited data on the effectiveness and safety of the real-world use of golimumab in Asian patients. Methods:This was a multicenter, prospective, observational study. We enrolled patients with moderate-to-severe UC who were administered subcutaneous golimumab at 46 medical centers between May 2014 and November 2019. The primary outcome was the effectiveness and safety of golimumab at week 22. Clinical outcomes and adverse events were assessed according to partial Mayo score at weeks 0, 2, 6, 14, and 22.Results: A total of 130 patients were included (mean age: 45.7±16.0 years). The clinical response/ remission rates at weeks 2, 6, 14, and 22 were 40.4%/22.9%, 56.0%/35.8%, 70.6%/49.5%, and 67.9%/48.6%, respectively. Based on full Mayo score at week 14, clinical response and remission rates were 84.2% and 39.5%, respectively. Mucosal healing rate was 65.8%. In multivariate analysis with logistic regression, longer disease duration was significantly associated with a higher clinical response rate (adjusted odds ratio [aOR], 1.136; 95% confidence interval [CI], 1.006 to 1.282; p=0.040 at week 6; aOR, 1.256; 95% CI, 1.049 to 1.503; p=0.013 at week 22). A higher baseline Mayo endoscopic subscore was significantly associated with a lower clinical response rate at week 6 (aOR, 0.248; 95% CI, 0.089 to 0.692; p=0.008). The incidence of adverse drug reactions was 4.6% (6/130, nine events). No serious unexpected adverse drug reactions or deaths were reported. Conclusions:Golimumab was effective and safe as an induction and maintenance treatment for Korean patients with moderate-to-severe UC.

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Use of thiopurines in inflammatory bowel disease: an update

Cited by 59 publications

References 110 publications

Impact of Immunosuppressive Therapy on the Performance of Latent Tuberculosis Screening Tests in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Impact of Immunosuppressive Therapy on the Performance of Latent Tuberculosis Screening Tests in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Ulcerative Colitis in Adulthood and in Older Patients: Same Disease, Same Outcome, Same Risks?

Effectiveness and Safety of Golimumab in Patients with Ulcerative Colitis: A Multicenter, Prospective, Postmarketing Surveillance Study

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