Digestive Health Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Division of Gastroenterology, University of California, San Diego, La Jolla, California.
Gastroenterology. 2019 Jan;156(1):36-42. doi: 10.1053/j.gastro.2018.08.043. Epub 2018 Sep 7.
Thiopurines (azathioprine, mercaptopurine, thioguanine) and methotrexate are widely used in a variety of clinical management scenarios for ulcerative colitis and Crohn's disease. With the introduction of biologic therapies over the last 2 decades, controversies have emerged as to how these immunomodulators should be used in clinical practice, either alone as monotherapies or in combination with biologic therapies. Here, we provide a summary of evidence and our interpretations regarding how physicians can or should incorporate these agents into clinical practice. We have organized the review into sections regarding their utility as monotherapy or as combination therapy with biologics and safety considerations. Clinical pharmacologic considerations are important regarding both efficacy and safety.
硫唑嘌呤（巯嘌呤、硫鸟嘌呤）和甲氨蝶呤广泛用于溃疡性结肠炎和克罗恩病的多种临床治疗方案。在过去 20 年中生物疗法问世后，出现了关于这些免疫调节剂在临床实践中应如何单独使用（作为单药治疗）或与生物疗法联合使用的争议。在这里，我们总结了有关这些药物在临床实践中如何应用的证据和我们的解释。我们根据其作为单药治疗或与生物制剂联合治疗的用途以及安全性考虑因素对综述进行了分类。临床药理学考虑因素对于疗效和安全性都很重要。
