Thiopurine-induced pancreatitis in inflammatory bowel diseases

Abstract

Crohn’s disease and ulcerative colitis are chronic inflammatory conditions affecting the gut and can present at any age with increased numbers of diagnoses seen in many countries in recent years. The thiopurine drugs, azathioprine and 6-mercaptopurine, are commonly used to maintain remission in Crohn’s disease and ulcerative colitis; however, the use of these drugs may be limited by the development of pancreatitis in some individuals. Recent data indicate a genetic risk factor and provides a potential immune-mediated mechanism for thiopurine-induced pancreatitis. Management of thiopurine-induced pancreatitis requires exclusion of the triggering drug, which leads to prompt resolution of symptoms. This thiopurine side-effect may limit therapeutic options for future management of patients.

Keywords:

• 6-mercaptopurine
• azathioprine
• Crohn’s disease
• pancreatitis
• thiopurines
• ulcerative colitis

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• The thiopurine group of drugs includes azathioprine and 6-mercaptopurine.

• The thiopurines are commonly utilized in the maintenance of remission in Crohn’s disease and ulcerative colitis.

• Approximately 5% of individuals with Crohn’s disease or ulcerative colitis who are treated with a thiopurine develop acute pancreatitis (thiopurine-induced pancreatitis: TIP).

• TIP is typically self-limited and mild.

• TIP typically recurs upon recommencement of the same thiopurine, but in some patients, it does not recur upon commencement of the alternate thiopurine drug.

• The onset of TIP in individuals with Crohn’s disease or ulcerative colitis has been considered an unpredictable and idiosyncratic reaction.

• Developing data suggest that genetic factors may provide increased risk of developing TIP.