Premium
Review article: thiopurines in inflammatory bowel disease
Author(s) -
DERIJKS L. J. J.,
GILISSEN L. P. L.,
HOOYMANS P. M.,
HOMMES D. W.
Publication year - 2006
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2006.02980.x
Subject(s) - medicine , inflammatory bowel disease , inflammatory bowel diseases , crohn disease , gastroenterology , disease
Summary Background In the past 10–20 years, knowledge of both thiopurine pharmacology and ‐pharmacogenetics has been extended dramatically and used to develop new strategies to improve efficacy and reduce toxicity. Aim To review thiopurine efficacy, toxicity, pharmacology, pharmacogenetics, interactions in patients with inflammatory bowel disease. Special attention was paid to new strategies for optimization of pharmacotherapy. Methods To collect relevant scientific articles, a Pubmed search was performed from 1966 through January 2006 with the following key words (MeSH terms preferentially) in multiple combinations: ‘azathioprine’, ‘6‐mercaptopurine’, ‘6‐MP’, ‘6‐thioguanine’, ‘6‐TG’, ‘thiopurine(s)’, ‘metabolites’, ‘level(s)’, ‘TDM’, ‘TMPT’, ‘ITPA’, ‘genotype(s)’, ‘phenotype(s)’, ‘inflammatory bowel disease’, ‘Crohn(’s) disease’, ‘ulcerative colitis’. Results Strategies for optimization of pharmacotherapy include therapeutic drug monitoring of thiopurine metabolites, geno‐ or phenotyping crucial enzymes in thiopurine metabolism like thiopurine S‐methyltransferase and inosine triphosphate pyrophosphatase, and the use of thioguanine as such. Conclusions Thiopurine S‐methyltransferase genotyping and therapeutic drug monitoring are useful instruments for individualizing thiopurine pharmacotherapy of inflammatory bowel disease. Inosine triphosphate pyrophosphatase genotyping may be helpful in case of unexplainable myelotoxicity. In case of azathioprine‐ or mercaptopurine‐intolerance, thioguanine seems a promising alternative. However, more knowledge needs to be gathered about its potential hepatotoxicity.