Dept. of Internal Medicine, University of Messina, Messina, Italy.
J Crohns Colitis. 2012 Jun;6(5):588-96. doi: 10.1016/j.crohns.2011.11.007. Epub 2011 Dec 8.
Thiopurines represent the mainstay of immunosuppressive therapy in inflammatory bowel diseases. Since it is likely that response to therapy and adverse events depends on the genetic background of patients our study aimed to evaluate retrospectively response to therapy and safety in a mixed IBD population in Southern Europe.
We evaluated demographic and clinical data of our patients treated with thiopurines. after 6 months in responders and non-responders to therapy. Moreover the likelihood to remain in thiopurine monotherapy was evaluated in responders, whereas adverse events were investigated in all patients.
Among disease- and patient-related parameters a shorter disease duration, female gender and ileal disease in Crohn's patients were associated with better response. By ROC analysis, the best predictors of response were decreasing values of C-reactive protein and erythrocyte sedimentation rate. In the long-term more than half of IBD patients who responded at 6 months remained on monotherapy at 42 months. Flu-like syndrome represented the most frequent adverse event followed by abnormalities of liver function tests and myelotoxicity. Adverse events did occur at any time and were frequently impredictable.
In this retrospective study, thiopurines showed a good clinical efficacy, especially in patients with short duration of disease. Normalization of markers of systemic inflammation represents the most useful tool to assess response. Careful monitoring of patients is required during the whole duration of treatment although it may not prevent all severe complications.
硫嘌呤类药物是炎症性肠病（IBD）患者的主要免疫抑制剂。由于治疗反应和不良反应可能取决于患者的遗传背景，我们的研究旨在回顾性评估南欧混合 IBD 人群的治疗反应和安全性。
我们评估了接受硫嘌呤治疗的患者的人口统计学和临床数据。比较了治疗反应者和无反应者在治疗 6 个月时的这些数据。此外，还评估了治疗反应者继续单药治疗的可能性，同时调查了所有患者的不良反应。
在疾病和患者相关参数中，克罗恩病患者的疾病持续时间较短、女性和回肠疾病与更好的治疗反应相关。通过 ROC 分析，C 反应蛋白和红细胞沉降率降低是反应的最佳预测因素。在长期随访中，6 个月时应答的 IBD 患者中超过一半在 42 个月时仍维持单药治疗。流感样综合征是最常见的不良反应，其次是肝功能异常和骨髓抑制。不良反应可随时发生，且常常不可预测。
在这项回顾性研究中，硫嘌呤类药物显示出良好的临床疗效，特别是在疾病持续时间较短的患者中。全身炎症标志物的正常化是评估治疗反应最有用的工具。尽管可能无法预防所有严重并发症，但在整个治疗期间仍需对患者进行仔细监测。
