Thiopurines and Methotrexate Use in IBD Patients in a Biologic Era

Opinion StatementAlthough we have been living in the era of biologic therapy for several decades, the use of immunomodulators (primarily thiopurines [azathioprine and mercaptopurine] and less so methotrexate) still remains an important component of the inflammatory bowel disease (IBD) pharmaceutical arsenal. Thiopurines as monotherapy exert corticosteroid-sparing effects and can maintain long-term remission in a considerable proportion of patients who have frequent relapses and are or have become mesalazine and/or corticosteroid intolerant or refractory. Withdrawal of thiopurines results in relapse of disease in a significant proportion of patients. Thiopurines enhance the induction effect of anti-TNF α biologics and can reinstate disease remission in patients who lose response to anti-TNF monotherapy. In thiopurine-naïve ulcerative colitis (UC) patients with iv corticosteroid-refractory disease, thiopurines offer an excellent maintenance strategy after cyclosporine rescue therapy. They also pr event the postoperative recurrence of Crohn’s disease, especially in smokers, and can achieve response or remission in uncomplicated perianal fistulizing disease. Close monitoring of patients with sequential measurements of complete blood count, liver enzymes, serum and fecal biomarkers, and/or th iopurine metabolites is essential to assess efficacy, safety, and adherence to treatment. Adverse reactions are dose dependent or idiosyncratic. Idiosyncratic reactions to az...
Source: Current Treatment Options in Gastroenterology - Category: Gastroenterology Source Type: research

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Publication date: February 2020Source: The Journal of Chemical Thermodynamics, Volume 141Author(s): Fernando Hevia, Juan Antonio González, Ana Cobos, Isaías García de la Fuente, L.F. SanzAbstractRelative permittivities at 1 MHz, εr, at 0.1 MPa and (293.15–303.15) K and refractive indices, nD, at similar conditions have been measured for the alkan-1-ol (methanol, propan-1-ol, butan-1-ol, pentan-1-ol or heptan-1-ol) + N,N-diethylethanamine (TEA) systems. Positive values of the excess permittivities, εrE, are encountered for the methanol system at high alcohol concentration...
Source: The Journal of Chemical Thermodynamics - Category: Chemistry Source Type: research
Publication date: Available online 21 September 2019Source: Actas Urológicas Españolas (English Edition)Author(s): O. Yazici, A. Kafkasli, A. Erbin, M. Bilal Hamarat, A. Cubuk, O. Sarilar, K. SaricaAbstractPurposeTo evaluate the effect of JJ stents on SWL treatment of moderate (15–25 mm) renal pelvic stones.Materials and methodsBetween January 2016 and December 2017, a total of 152 adult patients who were planned to undergo SWL for a single radiopaque renal pelvic stone were included in the study. Patients with solitary kidney, congenital abnormality, skeletal tract abnormalities, previous urinary ...
Source: Actas Urologicas Espanolas - Category: Urology & Nephrology Source Type: research
ConclusionsIrregular width and appearance in ILs were identified successfully with within-section reproducibility. The moderate reproducibility across sections needs to be addressed in further studies by more systematic sampling of sections.SignificanceThe proposed protocol identifies irregularities in a reproducible manner and may suggest that irregular ILs could be used in paleopathology to identify pregnancies and diseases.LimitationsThe correlation between the identified irregular ILs and known pregnancies has not been assessed as part of this study.Suggestions for further researchThe identified irregular ILs need to b...
Source: International Journal of Paleopathology - Category: Pathology Source Type: research
We report the first family with autosomal dominant LPAC syndrome due to heterozygosity of the loss of function mutation c.2932T>C in ABCB4, identified by targeted next generation sequencing. PMID: 31538486 [PubMed - as supplied by publisher]
Source: Revista Espanola de Enfermedades Digestivas - Category: Gastroenterology Tags: Rev Esp Enferm Dig Source Type: research
CONCLUSIONS: forty-eight variants were identified in five genes including ABCB4, ABCB11, ATP8B1, SLC4A2 and GPBAR1, twenty-five of which were novel. This study expands the phenotypic and mutational spectrum in genes involved in bile acid homeostasis and highlights the genetic and phenotypic heterogeneity in patients with inherited liver disorders. PMID: 31538484 [PubMed - as supplied by publisher]
Source: Revista Espanola de Enfermedades Digestivas - Category: Gastroenterology Tags: Rev Esp Enferm Dig Source Type: research
Conference abstracts
Source: The Aspergillus Website - updates - Category: Respiratory Medicine Authors: Source Type: news
ConclusionHigh sensitivity, in particular for the presence of MA, associated with low specificity suggest that PIN and VARS questionnaires can be effective tools to identify those young patients who require specific neurological examinations in view of the prescription of a CHC or pregnancy planning.
Source: European Journal of Obstetrics and Gynecology and Reproductive Biology - Category: OBGYN Source Type: research
Publication date: Available online 21 September 2019Source: European Journal of Obstetrics &Gynecology and Reproductive BiologyAuthor(s): Gillian A. Ryan, Denis J. Crankshaw, John J. MorrisonAbstractObjectiveThe aim of this study was to compare the effects of oxytocin and ergometrine on the intrinsic contractile parameters of human uterine smooth muscle at term between primiparous and multiparous women.Study DesignMyometrial biopsies were obtained from women undergoing planned caesarean section at term. The biopsies were dissected into eight uniform strips and mounted in tissue baths for isometric recording. The strips...
Source: European Journal of Obstetrics and Gynecology and Reproductive Biology - Category: OBGYN Source Type: research
Publication date: Available online 21 September 2019Source: European Journal of Obstetrics &Gynecology and Reproductive BiologyAuthor(s): Luis Alonso Pacheco, Antonio Simone Laganà, Simone Garzon, Arantxa Perez Garrido, Alberto Flores Gornes, Fabio GhezziABSTRACTObjectiveTo evaluate the effectiveness of hysteroscopic outpatient metroplasty in women with T-shaped uterus and primary reproductive failure.Study DesignProspective cohort study including nulliparous women with primary unexplained infertility, repeated in vitro fertilization (IVF) failure or recurrent spontaneous miscarriage and T-shaped uterus anomaly ...
Source: European Journal of Obstetrics and Gynecology and Reproductive Biology - Category: OBGYN Source Type: research
Publication date: Available online 21 September 2019Source: European Journal of Obstetrics &Gynecology and Reproductive BiologyAuthor(s): Misgav Rottenstreich, Khaled Mosmar, Zvi Ehrlich, Ella Kitroser, Sorina Grisaru-Granovsky
Source: European Journal of Obstetrics and Gynecology and Reproductive Biology - Category: OBGYN Source Type: research
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