Optimizing immunomodulator therapy for inflammatory bowel disease

被引：32

作者：

Marla C. Dubinsky

机构：

[1] Pediatric IBD Center, Cedars-Sinai Medical Center, Los Angeles, CA 90048

来源：

Current Gastroenterology Reports | 2003年 / 5卷 / 6期

关键词：

Inflammatory Bowel Disease; Infliximab; Thiopurine; TPMT Activity; Balsalazide;

D O I：

10.1007/s11894-003-0041-7

中图分类号：

学科分类号：

摘要：

6-Mercaptopurine (6-MP) and its prodrug azathioprine (AZA) remain the mainstay of immunomodulator therapy for the maintenance of steroid-free remission in patients with inflammatory bowel disease (IBD). Traditional dosing strategies for initiation of thiopurines are often based on weight or empirically chosen. Dosing based on an understanding of an inherited difference in drug disposition and metabolism may provide a safer alternative. The thiopurine methyltransferase (TPMT) enzyme plays a pivotal role in the metabolism of 6-MP and AZA and is critical to the determination of thiopurine toxicity. The therapeutic benefits of thiopurines correlate best with concentration of the active 6-thioguanine (6-TGN) metabolites. Reports suggest that therapeutic response can be maximized when patients achieve therapeutic 6-TGN levels. Pharmacogenetic dosing based on TPMT and pharmacokinetic dosing based on 6-TGN levels may offer a safety and efficacy advantage over traditional dosing strategies and provide a novel mechanism for optimizing immunomodulator therapy in IBD. Copyright © 2003 by Current Science Inc.

引用

页码：506 / 511

页数：5

共 39 条

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