| International Session（Symposium）3(JSGE・JGES・JSGS・JSGCS) |
| Thu. November 5th 14:00 - 17:00 Room 11: Portopia Hotel South Wing Topaz |
| Thiopurine for IBD - Is it unnecessary anymore or should it be used properly? | |||
| Tadakazu Hisamatsu | |||
| Department of Gastroenterology and Hepatology, Kyorin University School of Medicine | |||
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| Thiopurine has been used to maintain clinical remission in IBD. In biologics era, thiopurines also play a role to inhibit to induce anti-drug antibody of TNF inhibitors in addition to efficacy of itself. SONIC study demonstrated clinical benefit of concomitant use of thiopurines with IFX in bio-naïve Crohn’s disease. DIAMOND study conducted in Japan showed evidence regarding combination therapy of ADA with thiopurines. Regarding use of thiopurines in management of IBD, we must consider the risk of acute and long-term adverse effects. Recently, NUDT15 codon 139 variant was identified the risk of acute sever leukopenia and acute total hair loss, especially in Asian population. As long-term adverse effect of thiopurines, malignancy including as non-melanoma skin cancer and lymphoma should be concerned. Most of evidence about risk of malignancy in thiopurine use have been reported in Western population. On the other hand, evidence from Japan showed that the risk of lymphoma in thiopurine use in Japanese IBD patients was relatively lower than it in Western population. New biologics have shown relatively lower antigenicity, but the risk of loss of response never goes to zero. Only few evidence regarding concomitant use of thiopurines in novel biologics having different mode of action from TNF inhibitors have been reported. Thus, in new biologics era, it is necessary to reconsider the position of thiopurine in IBD management. |
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Index Term 1: inflammatory bowel disease Index Term 2: thiopurine |
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