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Conventional Medical Management of Crohn’s Disease: Azathioprine and 6-Mercaptopurine

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Crohn's Disease and Ulcerative Colitis

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Abstract

Until the last decade azathioprine (AZA) and its metabolite, 6-mercaptopurine (6-MP), were potent drugs reserved for patients with severe Crohn’s disease. These purine analogues were thought to affect immune function by interfering with the synthesis of nucleic acid. Systematic reviews and meta-analyses provide evidence for both the induction of remission and the maintenance of remission in Crohn’s disease patients. There is also evidence for a steroid-sparing effect. A healing effect for patients who have fistulous disease has also been demonstrated.

The introduction of biologics has had a great impact on the treatment of Crohn’s disease. An important limitation was the development of antibodies to the biologic with a subsequent loss of clinical response. This finding has resulted in trials examining the efficacy of combination therapy (biologic/AZA vs. monotherapy with either biologic or AZA). The SONIC Trial has confirmed the effectiveness of combination therapy.

However, the reporting of serious infections and lymphoproliferative disorders has raised concerns in the IBD community. Approximately 10% of patients who receive AZA/6MP will not tolerate the therapy. Regular blood testing is recommended to monitor leukopenia or drug metabolite levels.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, University of Calgary, Room 3D08, TRW Building, 3280 Hospital Dr NW, Calgary, AB, Canada, T2N 4Z6

    Gil Kaplan MD, MPH & Lloyd R. Sutherland MDCM, FRCPC, FACP

Authors
  1. Gil Kaplan MD, MPH
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  2. Lloyd R. Sutherland MDCM, FRCPC, FACP
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Corresponding author

Correspondence to Lloyd R. Sutherland MDCM, FRCPC, FACP .

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Editors and Affiliations

  1. Medical School of the Humboldt Universit, Department of Medicine, Charité Medical Center, Virchow Hospita, Berlin, 13344, Germany

    Daniel C. Baumgart

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Kaplan, G., Sutherland, L.R. (2012). Conventional Medical Management of Crohn’s Disease: Azathioprine and 6-Mercaptopurine. In: Baumgart, D. (eds) Crohn's Disease and Ulcerative Colitis. Springer, Boston, MA. https://doi.org/10.1007/978-1-4614-0998-4_29

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  • DOI: https://doi.org/10.1007/978-1-4614-0998-4_29

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  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4614-0997-7

  • Online ISBN: 978-1-4614-0998-4

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