Digestive Diseases Clinical Academic Unit, Barts, and the London School of Medicine and Dentistry, Queen Mary's University, London, UK.
J Pediatr Gastroenterol Nutr. 2011 Jun;52(6):702-7. doi: 10.1097/MPG.0b013e31820ba46c.
Children and adolescents with inflammatory bowel disease (IBD) have more extensive and severe disease than adults. Despite a lack of comparative studies, thiopurines are frequently cited as being more efficacious in children. To test this assertion, we compared the efficacy of thiopurines in children with IBD with that in adults matched for disease phenotype.
Fifty paediatric and adult patients with IBD started on a thiopurine were matched for sex, disease type, and extent. Retrospective data were obtained by electronic case note review, and corticosteroid-free clinical remission and tolerance rates at 6 months as well as relapse rates during the subsequent year were recorded.
Adverse effects caused discontinuation of thiopurines in 1 of 50 children and 16% (8/50) of adults (P < 0.05). At 6 months, steroid-free remission was achieved in 30% (15/50) of children and 38% (19/50) of adults (P = 0.53). No differences in remission rates were seen according to disease type. At the end of the following year, 73% (11/15) of children and 68% (13/19) of adults remained in remission (P = 1).
Thiopurines are tolerated better by children. When phenotype is matched, there is no difference in the therapeutic response to thiopurines between children and adults with IBD.
儿童和青少年炎症性肠病（IBD）的疾病程度比成年人更广泛和严重。尽管缺乏比较研究，但硫嘌呤类药物在儿童中被认为更有效。为了验证这一说法，我们比较了儿童和成人 IBD 患者在疾病表型匹配的情况下硫嘌呤类药物的疗效。
50 名接受硫嘌呤治疗的儿童和成人 IBD 患者根据性别、疾病类型和范围进行匹配。通过电子病历回顾获得回顾性数据，并记录 6 个月时无皮质类固醇的临床缓解率和耐受性率，以及随后 1 年内的复发率。
有 1 名儿童（1/50）和 16%（8/50）的成年人（P<0.05）因不良反应而停止使用硫嘌呤。6 个月时，30%（15/50）的儿童和 38%（19/50）的成年人达到无皮质类固醇缓解（P=0.53）。根据疾病类型，缓解率无差异。在接下来的一年结束时，73%（11/15）的儿童和 68%（13/19）的成年人仍处于缓解状态（P=1）。
儿童对硫嘌呤的耐受性更好。当表型匹配时，儿童和成人 IBD 患者对硫嘌呤的治疗反应没有差异。
