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Use of thiopurines in inflammatory bowel disease: an update
( Arshdeep Singh ),( Ramit Mahajan ),( Saurabh Kedia ),( Amit Kumar Dutta ),( Abhinav Anand ),( Charles N. Bernstein ),( Devendra Desai ),( C. Ganesh Pai ),( Govind Makharia ),( Harsh Vardhan Tevethia 대한장연구학회 2022 Intestinal Research Vol.20 No.1
Inflammatory bowel disease (IBD), once considered a disease of the Western hemisphere, has emerged as a global disease. As the disease prevalence is on a steady rise, management of IBD has come under the spotlight. 5-Aminosalicylates, corticoste roids, immunosuppressive agents and biologics are the backbone of treatment of IBD. With the advent of biologics and small molecules, the need for surgery and hospitalization has decreased. However, economic viability and acceptability is an im portant determinant of local prescription patterns. Nearly one-third of the patients in West receive biologics as the first/initial therapy. The scenario is different in developing countries where biologics are used only in a small proportion of patients with IBD. Increased risk of reactivation of tuberculosis and high cost of the therapy are limitations to their use. Thiopurines hence become critical for optimal management of patients with IBD in these regions. However, approximately one-third of patients are intolerant or develop adverse effects with their use. This has led to suboptimal use of thiopurines in clinical practice. This review article discusses the clinical aspects of thiopurine use in patients with IBD with the aim of optimizing their use to full therapeutic potential. (Intest Res 2022;20:11-30)
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