Department of Pediatric Gastroenterology and Hepatology and Nutrition, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
TARGID, Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium.
Paediatr Drugs. 2020 Oct;22(5):449-461. doi: 10.1007/s40272-020-00411-5.
Thiopurines have been widely used to maintain steroid-free remission in children with inflammatory bowel disease (IBD). However, within the expanding treatment armamentarium, the role of these non-selective immunomodulators has been questioned, especially in pediatric patients, who often present with a more aggressive disease course, which can impact growth and development. The less favorable safety but also inferior efficacy profile associated with thiopurines, in contrast to the newer biological therapies, has interfered with their use. The future place of thiopurines in the management of childhood IBD, therefore, needs revisiting. This review provides a practical overview on the historical and current use of thiopurines in pediatric IBD with specific attention for thiopurine S-methyltransferase testing and monitoring of thiopurine metabolite levels as an approach to improve outcomes. We also give a personal expert opinion on the future role of these drugs in childhood IBD.
硫嘌呤类药物已广泛用于维持儿童炎症性肠病（IBD）的无类固醇缓解。然而，在不断扩大的治疗手段中，这些非选择性免疫调节剂的作用受到了质疑，特别是在儿科患者中，他们的疾病往往更具侵袭性，这可能会影响生长发育。与新型生物疗法相比，硫嘌呤类药物的安全性较差，疗效也较差，这妨碍了它们的应用。因此，需要重新审视硫嘌呤类药物在儿童 IBD 治疗中的未来地位。本文综述了硫嘌呤类药物在儿科 IBD 中的历史和现状，特别关注硫嘌呤 S-甲基转移酶检测和硫嘌呤代谢物水平监测，以改善治疗效果。我们还对这些药物在儿童 IBD 中的未来作用提出了个人专家意见。
