Common misconceptions about 5-aminosalicylates and thiopurines in inflammatory bowel disease  

作　　者：Javier P Gisbert María Chaparro Fernando Gomollón 

机构地区：[1]Gastroenterology Unit,Hospital Universitario de La Princesa,Instituto de Investigación SanitariaPrincesa(IP)and Centro de Investigación Biomédica en Red de Enfermedades Hepáticasy Digestivas,28006 Madrid,Spain [2]Gastroenterology Unit,Hospital Clínico Universitario and Centro de Investigación Biomédica en Redde Enfermedades Hepáticasy Digestivas,IACS,50009 Zaragoza,Spain

出　　处：《World Journal of Gastroenterology》2011年第30期3467-3478,共12页世界胃肠病学杂志（英文版）

摘　　要：Misconceptions are common in the care of patients with inflammatory bowel disease(IBD).In this paper,we state the most commonly found misconceptions in clinical practice and deal with the use of 5-aminosalicylates and thiopurines,to review the related scientificevidence,and make appropriate recommendations.Prevention of errors needs knowledge to avoid making such errors through ignorance.However,the amount of knowledge is increasing so quickly that one new danger is an overabundance of information.IBD is a model of a very complex disease and our goal with this review is to summarize the key evidence for the most common daily clinical problems.With regard to the use of 5-aminosalicylates,the best practice may to be consider abandoning the use of these drugs in patients withsmall bowel Crohn's disease.The combined approach with oral plus topical 5-aminosalicylates should be the first-line therapy in patients with active ulcerative colitis;once-daily treatment should be offered as a first choice regimen due to its better compliance and higher efficacy.With regard to thiopurines,they seem to be as effective in ulcerative colitis as in Crohn's disease.Underdosing of thiopurines is a form of undertreatment.Thiopurines should probably be continued indefinitely because their withdrawal is associated with a high risk of relapse.Mercaptopurine is a safe alternative in patients with digestive intolerance or hepatotoxicity due to azathioprine.Finally,thiopurine methyltransferase(TPMT)screening cannot substitute for regular monitoring because the majority of cases of myelotoxicity are not TPMT-related.Misconceptions are common in the care of patients with inflammatory bowel disease （IBD）. In this paper, we state the most commonly found misconceptions in clinical practice and deal with the use of 5-aminosalicylates and thiopurines, to review the related scientific evidence, and make appropriate recommendations. Prevention of errors needs knowledge to avoid making such errors through ignorance. However, the amount of knowledge is increasing so quickly that one new danger is an overabundance of information. IBD is a model of a very complex disease and our goal with this review is to summarize the key evidence for the most common daily clinical problems. With regard to the use of 5-aminosalicylates, the best practice may to be con- sider abandoning the use of these drugs in patients with small bowel Crohn＇ s disease. The combined approach with oral plus topical 5-aminosalicylates should be the first-line therapy in patients with active ulcerative colitis; once-daily treatment should be offered as a first choice regimen due to its better compliance and higher efficacy. With regard to thiopurines, they seem to be as effective in ulcerative colitis as in Crohn＇ s disease. Underdosing of thiopurines is a form of undertreatment. Thiopurines should probably be continued indefinitely because their withdrawal is associated with a high risk of relapse. Mer- captopurine is a safe alternative in patients with digestive intolerance or hepatotoxicity due to azathioprine. Finally, thiopurine methyltransferase （TPMT） screening cannot substitute for regular monitoring because the majority of cases of myelotoxicity are not TPMT-related.

关 键 词：Crohn＇ s disease Ulcerative colitis Inflam-matory bowel disease AMINOSALICYLATES STEROIDS AZATHIOPRINE MERCAPTOPURINE Misconceptions 

分 类 号：R574.62[医药卫生—消化系统]