Discussion

Thiopurines benefit patients with UC or CD for maintenance of remission and may also improve CD disease course via their steroid-sparing effect and capacity to reduce surgery requirements.^3,6,15 However, meta-analyses show that thiopurines do not induce remission in UC or CD. ^6,7 This is probably related to the slow onset of action of this drug class compared with corticosteroids or anti-TNF agents.¹⁷ Furthermore, thiopurines do not have a favorable safety profile, as approximately 20% of patients are intolerant to treatment.^4,18 This may explain the difference in outcomes observed in withdrawal studies, which have an inherent bias toward patients who are tolerant and respond to treatment, as opposed to add-on interventional studies.

The quality of the studies on this class of drugs is low,³ which was likely a factor that led to varying degrees of agreement on this statement. There was a 50/50 split on agreeing with or rejecting the statement both among the faculty and the surveyed gastroenterologists, but none of the faculty voted to “Agree completely” or “Reject completely” with the statement.