Azathioprin in der Therapie des Morbus Crohn – eine Standortbestimmung vor dem Hintergrund aktueller Studien

C. Schmidt; K. Herrlinger; B. Siegmund; B. Bokemeyer; S. Schreiber; A. Stallmach; für das Kompetenznetz Darmerkrankungen

doi:10.1055/s-0034-1385650

Zeitschrift für Gastroenterologie, Inhaltsverzeichnis

Z Gastroenterol 2014; 52(12): 1423-1430
DOI: 10.1055/s-0034-1385650

Übersicht

Azathioprin in der Therapie des Morbus Crohn – eine Standortbestimmung vor dem Hintergrund aktueller Studien

Azathioprine in Crohn’s disease therapy – guidance against the background of recent studies

C. Schmidt

¹Klinik für Innere Medizin IV, Universitätsklinikum Jena

,

K. Herrlinger

²Innere Medizin I, Asklepios Klinik Nord, Hamburg

,

B. Siegmund

³Medizinische Klinik m. S. Gastroenterologie, Infektiologie und Rheumatologie, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin

,

B. Bokemeyer

⁴Gastroenterologische Gemeinschaftspraxis Minden

,

S. Schreiber

⁵Klinik für Innere Medizin I, Universitätsklinikum Schleswig-Holstein, Kiel

,

A. Stallmach

¹Klinik für Innere Medizin IV, Universitätsklinikum Jena

,

für das Kompetenznetz Darmerkrankungen

› Institutsangaben

Abstract

Zusammenfassung

Thiopurine (Azathioprin oder 6-Mercaptopurin) sind die am häufigsten eingesetzten Immunsuppressiva in der Therapie des M. Crohn. In den aktuellen Leitlinien der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) von 2014 und der European Crohn‘s and Colitis Organisation (ECCO) von 2010 werden verschiedene Indikationen für diese Therapie definiert. Durch aktuelle Publikationen, die die Effektivität einer frühzeitig eingeleiteten Therapie adressieren und nach der Veröffentlichung der oben genannten Leitlinien publiziert wurden, wird jedoch sowohl bei Erwachsenen als auch bei Kindern die Wirksamkeit von Azathioprin substanziell infrage gestellt. In dieser Übersicht werden deshalb die aktuellen Studiendaten vor dem Hintergrund der seit vielen Jahren erarbeiteten Erkenntnisse zur Effektivität von Azathioprin und 6-Mercaptupurin diskutiert und Anregungen für den zukünftigen Einsatz der Wirkstoffe in der Therapie des M. Crohn formuliert.

Abstract

Thiopurines (azathioprine and 6-mercaptopurine) are the most frequently used drugs in the treatment of patients with Crohn’s disease. In current guidelines published by the German Society of Gastroenterology, Nutritional and Metabolic Diseases (DGVS) in 2014 and by the European Crohn´s and Colitis Organisation (ECCO) in 2010 different indications have been suggested. However, efficacy of azathioprine has been substantially questioned by recent publications in adults as well as in children examining the efficacy of early initiation of this treatment. These articles were published after release of the aforementioned guidelines. Therefore, in this survey recently published data are discussed on the background of our knowledge on the efficacy of azathioprine and 6-mercaptopurine developed in many years, and suggestions for the future use of these substances in the treatment of patients with Crohn's disease will be provided.

Schlüsselwörter

chronisch-entzündliche Darmerkrankung - Morbus Crohn - Azathioprin - 6-Mercaptopurin - Thiopurin

Key words

chronic inflammatory bowel disease - Crohn's disease - azathioprine - 6-mercaptopurine - thiopurines

Volltext

Referenzen

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