In certain areas of the globe, the use of thiopurines for inflammatory bowel disease (IBD) is diminishing. Researchers wanted to look at the effects of thiopurines and determinants of response in a real-world prospective cohort of children who were given dosage optimization. Children with IBD who were not receiving biologics were recruited in the study. Dosing was guided by thiopurine S-methyltransferase activity at baseline and clinical response and toxicity at 4 months; 1 year into the trial, therapeutic medication monitoring at 4 months was also taken into account. Using an intention-to-treat strategy, the primary outcome was steroid-free remission without therapy escalation by 12 months (SFR). There were 129 children in all. SFR was obtained in 37 CD and 13 UC patients, respectively, as was SFR with normal erythrocyte sedimentation rate/C-reactive protein in 20 and 9, respectively. At 4 months, the mean corpuscular volume/white blood cell ratio and absolute neutrophil count were very slightly linked to 6-thioguanine. SFR was linked to the 4-month median weighted Pediatric Crohn Disease Activity Index in CD patients. Mild medication-related side effects were reported in 30 children, with three requiring the medicine to be discontinued.

Thiopurines were safe and efficacious in 21 percent of CD and 27 percent of UC patients in this real-life prospective cohort utilizing dosage optimization, including the normalization of C-reactive protein and erythrocyte sedimentation rate. Thiopurines are still a feasible choice in the therapy strategy for mild-moderate juvenile IBD, particularly in females who have a decreased risk of malignancy.

Reference:https://journals.lww.com/jpgn/Fulltext/2020/06000/Role_of_Thiopurines_in_Pediatric_Inflammatory.25.aspx