Current Treatment Options in Gastroenterology

, Volume 4, Issue 3, pp 199–205

Immunomodulator therapy in inflammatory bowel disease

  • Peter E. Legnani
  • Asher Kornbluth

DOI: 10.1007/s11938-001-0032-4

Cite this article as:
Legnani, P.E. & Kornbluth, A. Curr Treat Options Gastro (2001) 4: 199. doi:10.1007/s11938-001-0032-4

Opinion statement

  • 6-Mercaptopurine and its prodrug counterpart, azathioprine, have proven efficacy in the induction and maintenance of remission, fistula closure, and steroid sparing in patients with Crohn’s disease. Long-term follow-up has demonstrated the safety of the purine analogues, with no increased risk of malignancy. For patients with Crohn’s disease intolerant or unresponsive to azathioprine or 6-mercaptopurine, methotrexate has emerged as an effective alternative.

  • In patients with severe ulcerative colitis, intravenous cyclosporine is highly efficacious in the short term, and with the addition of azathioprine or 6-mercaptopurine to oral cyclosporine, long-term remission rates of 60% to 70% can be achieved. Azathioprine or 6-mercaptopurine therapy is effective in patients with steroid-dependent or steroid-refractory colitis and is valuable in maintaining remission. Neither methotrexate nor cyclosporine has been shown to be effective for maintenance therapy in patients with ulcerative colitis.

  • Current data are insufficient to recommend routine use of genetic or enzymatic testing of thiopurine methyltransferase or measurements of blood 6-thioguanine metabolites to guide 6-mercaptopurine or azathioprine dosing.

Copyright information

© Current Science Inc 2001

Authors and Affiliations

  • Peter E. Legnani
    • 1
  • Asher Kornbluth
    • 1
  1. 1.The Dr. Henry D. Janowitz Division of Gastroenterology, Department of MedicineThe Mount Sinai School of MedicineNew YorkUSA