Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2016; 22(46): 10103-10117
Published online Dec 14, 2016. doi: 10.3748/wjg.v22.i46.10103
Thiopurines and inflammatory bowel disease: Current evidence and a historical perspective
Jordan E Axelrad, Abhik Roy, Garrett Lawlor, Burton Korelitz, Simon Lichtiger
Jordan E Axelrad, Garrett Lawlor, Simon Lichtiger, Department of Medicine, Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY 10032, United States
Abhik Roy, Department of Medicine, Division of Gastroenterology, University of California, San Francisco, CA 94143, United States
Burton Korelitz, Department of Medicine, Division of Gastroenterology, Northwell Health Lenox Hill Hospital, New York, NY 10032, United States
Author contributions: Axelrad JE, Roy A, Lawlor G, Korelitz B and Lichtiger S wrote the paper.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jordan E Axelrad, MD, MPH, Department of Medicine, Division of Digestive and Liver Diseases, Columbia University Medical Center, 630 West 168th Street, Box 83, Presbyterian Hospital 7 West, Room 318, New York, NY 10032, United States. ja3064@cumc.columbia.edu
Telephone: +1-212-3424776 Fax: +1-212-3425759
Received: October 20, 2016
Peer-review started: October 21, 2016
First decision: November 9, 2016
Revised: November 10, 2016
Accepted: November 23, 2016
Article in press: November 28, 2016
Published online: December 14, 2016
Processing time: 53 Days and 19.7 Hours
Abstract

The use of thiopurines in inflammatory bowel disease (IBD) has been examined in numerous prospective, controlled trials, with a majority demonstrating a clinical benefit. We conducted this review to describe the historical and current evidence in the use of thiopurines in IBD. A systematic search was performed on MEDLINE between 1965 and 2016 to identify studies on thiopurines in IBD. The most robust evidence for thiopurines in IBD includes induction of remission in combination with anti-tumor necrosis factor (anti-TNF) agents, and maintenance of remission and post-operative maintenance in Crohn’s disease. Less evidence exists for thiopurine monotherapy in induction of remission, maintenance of ulcerative colitis, chemoprevention of colorectal cancer, and in preventing immunogenicity to anti-TNF. Evidence was often limited by trial design. Overall, thiopurines have demonstrated efficacy in a broad range of presentations of IBD. With more efficacious novel therapeutic agents, the positioning of thiopurines in the management of IBD will change and future studies will analyze the benefit of thiopurines alone and in conjunction with these new medications.

Keywords: Inflammatory bowel disease; Ulcerative colitis; Crohn’s disease; Thiopurines; Mercaptopurine; Azathioprine

Core tip: In this review, we systematically describe the historical and current evidence in the use of thiopurines in inflammatory bowel disease (IBD). The most robust evidence for thiopurines in IBD includes induction of remission in combination with anti-tumor necrosis factor agents, and maintenance of remission and post-operative maintenance in Crohn’s disease. With more effective and newer therapeutic agents, the positioning of thiopurines in the management of IBD will change. Future studies should examine the benefit of thiopurines alone and in conjunction with these novel agents.