Abstract
Thiopurines are effective in maintaining remission in chronic inflammatory bowel diseases, but incomplete response or side effects are common during standard-dose treatment. In this article thiopurine metabolism and pharmacogenetic aspects are summarized showing their benefits in improving therapy in chronic inflammatory bowel disease. An increasing body of evidence suggests that a large part of the observed non-pancreatic side effects and poor responses can be solved by tailoring thiopurine therapy using measurement of thiopurine methyltransferase and metabolites and by using a combination therapy with low-dose thiopurines and allopurinol.
MeSH terms
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Algorithms
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Allopurinol / administration & dosage
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Allopurinol / adverse effects
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Allopurinol / metabolism
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Allopurinol / therapeutic use
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Antimetabolites / administration & dosage
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Antimetabolites / adverse effects
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Antimetabolites / metabolism
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Antimetabolites / therapeutic use
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Azathioprine / administration & dosage
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Azathioprine / adverse effects
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Azathioprine / metabolism
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Azathioprine / therapeutic use*
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Dose-Response Relationship, Drug
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Drug Therapy, Combination
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Humans
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Immunosuppressive Agents / administration & dosage
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Immunosuppressive Agents / adverse effects
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Immunosuppressive Agents / metabolism
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Immunosuppressive Agents / therapeutic use*
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Inflammatory Bowel Diseases / drug therapy*
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Mercaptopurine / administration & dosage
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Mercaptopurine / adverse effects
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Mercaptopurine / metabolism
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Mercaptopurine / therapeutic use*
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Methyltransferases / administration & dosage
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Methyltransferases / adverse effects
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Methyltransferases / metabolism
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Methyltransferases / therapeutic use
Substances
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Antimetabolites
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Immunosuppressive Agents
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Allopurinol
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Mercaptopurine
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Methyltransferases
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Azathioprine