| Theme | Role of AZA/6-MP in the Treatment of Inflammatory Bowel Disease | |
|---|---|---|
| Title | Comparative Effect of Other Treatments with AZA/6-MP in the Steroid Dependent / Resistant Inflammatory Bowel Disease -- Cytapheresis (Leukocytic Cytapheresis ; LCP) | |
| Publish Date | 2007/11 | |
| Author | Koji Sawada | Department of General Medicine & Gastroenterology, Yao General Hospital |
| Author | Hitoshi Yasoshima | Department of Clinical Laboratory Medicine, Yao General Hospital |
| Author | Maiko Ohdo | Department of Clinical Laboratory Medicine, Yao General Hospital |
| [ Summary ] | As an intensive therapy, leukocytic cytapheresis (LCP) once a month is not adequate to maintain long term remission of ulcerative colitis (UC). Frequency of LCP should be increased to maintain sustained remission. Later usage of azathioprine (AZA) or 6-mercaptopurine (6-MP) with LCP is effective if either has been used in the early stages of LCP therapy because the effects of those immune suppressants are delayed. These immune suppressants must be used very carefully because adverse effects (especially bone marrow suppression) associated with 6-thioguanine (6-TG) may occur in some Japanese patients. The activity of thiopurine methyltransferase (TPMT) which is a metabolic enzyme of 6 TG (AZA/6-MP) is very low in Japanese. Furthermore, hereditary deformities were reported in AZA/6-MP animal studies so that it is also recommended to use each of them very carefully for the reproductive age patients. In basic UC treatment, attention must be paid to dietary factors and other factors such as stress. 5-ASA and pro-or pre-biotic medicines are combined for the treatment of UC patients together with LCP and / or AZA/6-MP. However, strong immune suppressants as cyclosporine and tacrolimus, biological drugs or surgery may be considered when the above mentioned combination therapy is not effective. |
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