目标:几十年来,硫嘌呤一直是炎症性肠病(IBD)治疗的主要药物,并将在未来发挥重要作用。然而,复杂的代谢和各种副作用限制了这些有效药物在临床实践中的使用。韩国肠道疾病研究协会制定了一套共识声明,旨在指导临床医生在IBD的管理中适当使用硫嘌呤。
方法:最初由五名委员会成员起草了16份声明。根据《建议分级评估》对证据质量和建议分级进行评估。开发和评估系统。然后将这些声明分发给韩国的IBD专家进行审查,反馈,然后在协商一致会议上最终确定并接受。
结果:共识声明包括四个部分:(1)治疗前评估和管理策略,包括硫嘌呤S-甲基转移酶筛选的价值,给药时间表,和预测硫嘌呤诱导的白细胞减少症的新生物标志物;(2)考虑到硫嘌呤治疗的最佳持续时间和抗肿瘤坏死因子联合治疗的长期结果;(3)硫嘌呤的安全性,尤其是在怀孕和哺乳期间;和(4)使用生物标志物监测治疗的副作用或功效。
结论:硫嘌呤是IBD患者的有效治疗选择。管理决策应根据复发和不良事件的风险进行个体化。
OBJECTIVE: For decades,
thiopurines have been the mainstay of inflammatory bowel disease (IBD) treatment and will play an important role in the future. However, complex metabolism and various side effects limit the use of these potent drugs in clinical practice. The Korean Association for the Study of Intestinal Diseases developed a set of
consensus statements with the aim of guiding clinicians on the appropriate use of
thiopurines in the management of IBD.
METHODS: Sixteen statements were initially drafted by five committee members. The quality of evidence and classification of recommendation were assessed according to the Grading of Recommendations Assessment, Development and Evaluation system. The statements were then circulated to IBD experts in Korea for review, feedback, and then finalized and accepted by voting at the
consensus meeting.
RESULTS: The
consensus statements comprised four parts: (1) pre-treatment evaluation and management strategy, including value of thiopurine S-methyltransferase screening, dosing schedule, and novel biomarkers for predicting thiopurine-induced leukopenia; (2) treatment with thiopurines with regards to optimal duration of thiopurine treatment and long-term outcomes of combination therapy with anti-tumor necrosis factors; (3) safety of thiopurines, especially during pregnancy and lactation; and (4) monitoring side effects or efficacy of therapy using biomarkers.
CONCLUSIONS: Thiopurines are an effective treatment option for patients with IBD. Management decisions should be individualized according to the risk of relapse and adverse events.