Toxicity and response to thiopurines in patients with inflammatory bowel disease
Toxicity and response to thiopurines in patients with inflammatory bowel disease
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DOI：
10.1586/17474124.2015.1039987
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发表时间：
2015-07-01
影响因子：
3.9
通讯作者：
Irving, Peter M.
中科院分区：
文献类型：
--
作者：
Goldberg, Rimma;Irving, Peter M.
硫嘌呤类药物在炎症性肠病的治疗中已得到广泛应用。几十年来积累的大量数据和经验支持其疗效，但最近受到试验的挑战，这些试验未能显示在克罗恩病病程早期使用时的获益，尽管其他试验继续支持其作为单药治疗和与抗TNF联合治疗的作用。最近也出现了以前未被认识到的毒性报告。幸运的是，严重毒性的绝对发生率仍然很低，对如何最大限度地降低风险的理解和对硫嘌呤毒性风险较高的患者群体的认识的提高意味着它们在大多数患者中仍然是相对安全的治疗方法。在本文中，我们回顾了文献评估硫嘌呤在炎症性肠病中的作用以及它们的毒性。我们的结论是，关于硫嘌呤副作用谱的教育和治疗期间的最佳监测可能有助于优化这些重要药物的安全性和有效性。
The use of thiopurines is well established in the management of inflammatory bowel disease. A wealth of data and experience, amassed over several decades, supporting their efficacy has recently been challenged by trials that failed to show a benefit in Crohn's disease when used early in the disease course, although other trials continue to support their role both as monotherapy and in combination with anti-TNF. Recent reports of previously unrecognized toxicity have also emerged. Fortunately, the absolute incidence of serious toxicity remains low, and an improved understanding of how best to minimize risk and the recognition of groups of patients at higher risk of toxicity from thiopurines means that they remain a relatively safe therapy in the majority of patients. In this paper, we review the literature evaluating the role of thiopurines in inflammatory bowel disease as well as their toxicity. We conclude that education regarding the spectrum of thiopurine side effects and optimal monitoring during therapy may help with optimizing safety and efficacy of these important medications.