Curbside Consultation in IBD: 49 Clinical Questions, Second Edition

David T Rubin, MD; Sonia Friedman, MD; Francis A Farraye, MD MSc

Question 16: How Do You Optimize Therapy With Thiopurines? (continued)

Antony B. Friedman, MBBS; Miles P. Sparrow, MBBS

The thiopurine immunomodulators, 6-mercaptopurine (6-MP) and its prodrug azathioprine (AZA), are well established in inflammatory bowel disease (IBD) treatment algorithms as induction, maintenance, and steroid-sparing agents. However, up to 60% of patients do not respond to the standard weight-based dose and duration of thiopurine therapy and up to 25% will experience some sort of adverse event with these agents. Given the relative paucity of alternate maintenance agents in IBD, thiopurine optimization remains an important priority before these agents are discontinued due to…