The use of thiopurines for the treatment of inflammatory bowel diseases in clinical practice

Background. Thiopurines are the most commonly used immunomodulatory drugs in inflammatory bowel diseases. Aim. To evaluate the use, the therapeutic and safety profiles of thiopurines in a large sample of IBD patients. Methods. We reviewed 3641 case histories of 11313 patients. Thiopurines were prescribed in 582 patients (16.0%); the analysis was performed on the 553 (267 ulcerative colitis, 286 Crohn's disease) with exhaustive clinical data. Results. The main indications for treatment were steroid-dependence (328/553, 59.3%) and steroid-resistance (113/553, 20.7%). Thiopurines were started when CD were younger than UC patients (p < 0.001) but earlier from diagnosis in UC than in CD patients (p = 0.003). Efficacy was defined as optimal (258/553, 46.6%), partial (108/553, 19.5%), absent (85/553, 15.4%) and not assessable (102/553, 18.4%). Efficacy was independent of disease type, location/extension or duration and age at starting. Side effects were observed in 151/553 (27.3%) patients, leading to drug discontinuation in 101 (18.3%). 15 out of the 130 (11.5%) patients who took thiopurines for more than 4 years relapsed, more frequently in CD than in UC (OR = 3.67 95% C.I. 0.98-13.69; p = 0.053). Conclusions. Thiopurines confirm their clinical usefulness and acceptable safety profile in managing complicated IBD patients. The majority of patients treated for longer than 4 years maintain response. No clinical and demographic predictive factors for efficacy and side effects were identified. (c) 2008 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.