Department of Hepato-Gastroenterology and Inserm U954, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France.
Inflamm Bowel Dis. 2011 Jun;17(6):1428-35. doi: 10.1002/ibd.21494. Epub 2010 Oct 14.
Despite recent advances, the therapeutic armamentarium for inflammatory bowel disease (IBD) is still limited. In addition, a step-up approach is recommended for most IBD patients. Thus, optimizing each medical therapy before switching to another drug class is the rule in clinical practice. Conventional therapies for IBD have not received the same amount of attention as biologic therapies over the last decade. However, due to their efficacy, safety, and low cost the thiopurine drugs azathioprine and 6-mercaptopurine remain the backbone of therapy for IBD. Pharmacogenomic advances and increased knowledge of their metabolism are allowing dosage optimization. Herein, after describing the pharmacogenetics and pharmacokinetics of thiopurines, we will discuss how to optimize thiopurine therapy. We will then underscore the need to take into account safety issues when optimizing thiopurine treatment.
尽管最近取得了进展，但炎症性肠病 (IBD) 的治疗方法仍然有限。此外，大多数 IBD 患者都推荐采用逐步升级的方法。因此，在切换到另一种药物类别之前优化每种医学治疗方法是临床实践中的规则。在过去十年中，IBD 的传统疗法并没有像生物疗法那样受到同样的关注。然而，由于其疗效、安全性和低成本，硫嘌呤药物硫唑嘌呤和 6-巯基嘌呤仍然是 IBD 治疗的基础。药物基因组学的进步和对其代谢的更多了解正在允许进行剂量优化。在此，在描述了硫嘌呤的药物遗传学和药代动力学之后，我们将讨论如何优化硫嘌呤治疗。然后，我们将强调在优化硫嘌呤治疗时需要考虑安全性问题。
