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PAPEL DE LA AZATIOPRINA Y LA 6-MERCAPTOPURINA EN EL TRATAMIENTO DE LA ENFERMEDAD INFLAMATORIA INTESTINAL

(especial para SIIC © Derechos reservados)
La posibilidad de que el tratamiento con Azatioprina y 6 Mercaptopurina en los pacientes con enfermedad inflamatoria intestinal se asocie con un incremento del riesgo de sufrir neoplasias no está definitivamente aclarada, pero en todo caso la probabilidad parece ser mínima y los beneficios del tratamiento compensan los riesgos potenciales.
gisbert.jpg Autor:
Javier p. Gisbert
Columnista Experto de SIIC
Artículos publicados por Javier p. Gisbert
Coautores
Fernando Gomollón* José Maté** José María Pajares** 
Servicio de Aparato Digestivo. Hospital Miguel Servet, Zaragoza, España*
Servicio de Aparato Digestivo. Hospital Universitario de la Princesa. Madrid, España**
Recepción del artículo
29 de Septiembre, 2003 		Aprobación
29 de Octubre, 2003
Primera edición
16 de Diciembre, 2003 		Segunda edición, ampliada y corregida
7 de Junio, 2021

PAPEL DE LA AZATIOPRINA Y LA 6-MERCAPTOPURINA EN EL TRATAMIENTO DE LA ENFERMEDAD INFLAMATORIA INTESTINAL

Resumen
La azatioprina (AZA) y la 6-mercaptopurina (6-MP) representan piezas clave en la terapia inmunodepresora de la enfermedad inflamatoria intestinal, fundamentalmente en los casos corticorresistentes y corticodependientes. Existe evidencia sobre su eficacia en la inducción de la remisión y el mantenimiento de ésta. Estos fármacos parecen ser útiles en la enfermedad de Crohn fistulizante, aunque la experiencia basada en estudios controlados es muy reducida. En niños, tanto los efectos beneficiosos como el perfil de seguridad son muy similares a los descritos en adultos. La dosis efectiva de AZA es de 2-3 mg/kg/día, y de 1.5 mg/kg/día para la 6-MP. Algunos estudios han demostrado correlación entre el fenotipo/genotipo de la tiopurina metiltransferasa (TPMT) y el riesgo de mielotoxicidad, aunque su monitorización no elimina la necesidad de continuar realizando controles analíticos periódicos. La AZA y la 6-MP no parecen ser teratogénicas, por lo que la decisión de suspenderlas antes de la concepción y durante el embarazo no está basada en la evidencia científica. La posibilidad de que el tratamiento con AZA/6-MP se asocie con mayor riesgo de sufrir neoplasias no está definitivamente aclarada; en todo caso, parece ser mínima, y los beneficios compensan los riesgos potenciales.

Palabras clave
Enfermedad de Crohn, colitis ulcerosa, enfermedad inflamatoria intestinal, azatioprina, 6-mercaptopurina, tiopurina metiltransferasa


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Especialidades
Principal: Gastroenterología
Relacionadas: Epidemiología, Farmacología, Inmunología, Medicina Interna



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