Singh Arshdeep, Mahajan Ramit, Kedia Saurabh, Dutta Amit Kumar, Anand Abhinav, Bernstein Charles N, Desai Devendra, Pai C Ganesh, Makharia Govind, Tevethia Harsh Vardhan, Mak Joyce Wy, Kaur Kirandeep, Peddi Kiran, Ranjan Mukesh Kumar, Arkkila Perttu, Kochhar Rakesh, Banerjee Rupa, Sinha Saroj Kant, Ng Siew Chien, Hanauer Stephen, Verma Suhang, Dutta Usha, Midha Vandana, Mehta Varun, Ahuja Vineet, Sood Ajit
Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, India.
Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India.
Intest Res. 2022 Jan;20(1):11-30. doi: 10.5217/ir.2020.00155. Epub 2021 Apr 15.
Inflammatory bowel disease (IBD), once considered a disease of the Western hemisphere, has emerged as a global disease. As the disease prevalence is on a steady rise, management of IBD has come under the spotlight. 5-Aminosalicylates, corticosteroids, immunosuppressive agents and biologics are the backbone of treatment of IBD. With the advent of biologics and small molecules, the need for surgery and hospitalization has decreased. However, economic viability and acceptability is an important determinant of local prescription patterns. Nearly one-third of the patients in West receive biologics as the first/initial therapy. The scenario is different in developing countries where biologics are used only in a small proportion of patients with IBD. Increased risk of reactivation of tuberculosis and high cost of the therapy are limitations to their use. Thiopurines hence become critical for optimal management of patients with IBD in these regions. However, approximately one-third of patients are intolerant or develop adverse effects with their use. This has led to suboptimal use of thiopurines in clinical practice. This review article discusses the clinical aspects of thiopurine use in patients with IBD with the aim of optimizing their use to full therapeutic potential.
炎症性肠病（IBD）曾被认为是西半球的一种疾病，现已成为一种全球性疾病。随着该疾病患病率稳步上升，IBD的管理受到了关注。5-氨基水杨酸类药物、皮质类固醇、免疫抑制剂和生物制剂是IBD治疗的主要手段。随着生物制剂和小分子药物的出现，手术和住院需求有所减少。然而，经济可行性和可接受性是当地处方模式的重要决定因素。在西方，近三分之一的患者将生物制剂作为首选/初始治疗。在发展中国家情况则不同，只有一小部分IBD患者使用生物制剂。结核再激活风险增加以及治疗费用高昂限制了它们的使用。因此，硫嘌呤对于这些地区IBD患者的优化管理至关重要。然而，约三分之一的患者对其使用不耐受或出现不良反应。这导致硫嘌呤在临床实践中未得到充分利用。这篇综述文章讨论了IBD患者使用硫嘌呤的临床情况，目的是将其使用优化至充分发挥治疗潜力。
