Goldberg Rimma, Irving Peter M
Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Expert Rev Gastroenterol Hepatol. 2015 Jul;9(7):891-900. doi: 10.1586/17474124.2015.1039987. Epub 2015 Apr 27.
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.
硫嘌呤类药物在炎症性肠病的治疗中应用广泛。数十年来积累的大量数据和经验支持其疗效，但近期一些试验对其提出了挑战，这些试验表明在克罗恩病病程早期使用硫嘌呤类药物并无益处，不过其他试验仍支持其作为单一疗法以及与抗TNF联合使用的作用。最近还出现了关于此前未被认识到的毒性的报道。幸运的是，严重毒性的绝对发生率仍然较低，并且对如何最好地降低风险的进一步了解以及对硫嘌呤类药物毒性风险较高患者群体的认识意味着，在大多数患者中它们仍然是相对安全的治疗方法。在本文中，我们回顾了评估硫嘌呤类药物在炎症性肠病中的作用及其毒性的文献。我们得出结论，关于硫嘌呤类药物副作用范围的教育以及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疗效。
