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 azathioprine, e...
Source: Current Treatment Options in Gastroenterology - Category: Gastroenterology Source Type: research