Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, 08916, Badalona, Catalonia, Spain.
Centro de Investigaciones Biomédicas en Red de Enfermedades Hepaticas y Digestivas, Madrid, Spain.
Drugs Aging. 2021 Mar;38(3):193-203. doi: 10.1007/s40266-020-00832-4. Epub 2021 Jan 13.
The number of older patients with inflammatory bowel disease (IBD) is increasing due to both improvements in the life expectancy of patients with long-lasting IBD and later onset of the disease. In spite of a less aggressive IBD phenotype, disease management in older patients is hampered by comorbidities and polypharmacy (which increase the risk of drug-related adverse events and errors in medication intake) and also by an increased risk of the infections and malignancies associated with the immunosuppressive drugs that are frequently used to treat IBD. Thiopurines are the most frequently used immunosuppressive drugs in IBD, though they are often discontinued due to adverse events. However, when tolerated, thiopurines are efficient in the maintenance of remission in ulcerative colitis and Crohn's disease. In fact, thiopurines still have a role to play in the treatment algorithm of older patients with IBD because anti-tumor necrosis factor agents do not provide clear advantages for this population in terms of their safety profile, while data on the new biological drugs are still scarce. In this article, we review the optimal use of thiopurines in older patients with IBD.
由于患有长期炎症性肠病（IBD）患者的预期寿命有所提高，以及该疾病的发病时间较晚，患有 IBD 的老年患者人数正在增加。尽管 IBD 的表型不太具有侵袭性，但由于合并症和多种药物治疗（这会增加与药物相关的不良反应和药物摄入错误的风险），以及与经常用于治疗 IBD 的免疫抑制剂相关的感染和恶性肿瘤的风险增加，老年患者的疾病管理受到阻碍。硫唑嘌呤是 IBD 中最常用的免疫抑制剂，但由于不良反应，它们经常被停用。然而，当耐受时，硫唑嘌呤在溃疡性结肠炎和克罗恩病的缓解维持中是有效的。事实上，硫唑嘌呤在 IBD 老年患者的治疗方案中仍有一定的作用，因为抗肿瘤坏死因子制剂在安全性方面并未为这一人群提供明显优势，而新的生物药物的数据仍然有限。在本文中，我们回顾了硫唑嘌呤在 IBD 老年患者中的最佳使用方法。
