In this era of biologic agents for inflammatory bowel disease (IBD), the estimation of the risks and the benefits of thiopurines has been changing (Clin Gastroenterol Hepatol 2013; 11: 395-97).
The referenced article is an editorial that reviews new data on thiopurines as well as provide a background for their usage.
Main points:
- After the SONIC trial, the usage of combination therapy in many IBD patients has regained favor with the main question: “How long to continue combination therapy?”
- STORI trial evaluated withdrawal of infliximab (IFX) in patients on combined therapy. More than 40% of patients who were withdrawn from IFX relapsed at 1 year.
- After >20 years of thiopurine usage, more data is available on both short-term and long-term risks/benefits. The risk of lymphoma in IBD patients on thiopurines is “4-fold increased…in the 6 evaluated studies.” Nonmelenoma skin cancer risk is increased by a hazard ratio of 5.9 in ongoing users and 3.9 in past thiopurine users.
- At the same time, more recent studies have lowered the expectation of benefit for thiopurines (AZTEC trial, Cosnes study).
Related references:
- Cosnes et al. Gastroenterol 2012; 142: s161.
- Gastroenterol 2012; 142: 63-70.
- Med Clin North Am 2010; 94: 93-113.
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