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There is still a place for optimised thiopurine therapy in IBD
  1. Femke Crouwel1,
  2. Hans J C Buiter2,
  3. Nanne K H de Boer1
  1. 1 Department of Gastroenterology and Hepatology, AGEM Research Insitute, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
  2. 2 Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
  1. Correspondence to Femke Crouwel, Gastroenterology and Hepatology, Amsterdam UMC Locatie VUmc, Amsterdam 1081 HV, The Netherlands; f.crouwel{at}

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With great interest, we have read the letter by Verstockt et al 1 considering the response rate and outcome of thiopurine monotherapy in patients with Crohn’s disease (CD). The title, however, stating that thiopurine monotherapy has a limited place in treatment of patients with mild-to-moderate CD raised some questions. Almost all patients in this retrospective cohort were treated with azathioprine (AZA) and nowhere is mentioned if patients who experience intolerance were switched to another thiopurine or received a rechallenge. A retrospective study among 1327 patients exposed both to AZA or mercaptopurine (MP) demonstrated, however, that almost half of patients intolerant to the first thiopurine were able to tolerate the second.2 In addition, another study demonstrated that almost 65% had clinical improvement during thioguanine (TG) treatment after AZA or MP failure, so switching could potentially lead to a higher response rate.3 Moreover, the discussed lack of therapeutic …

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  • Contributors FC drafted the first version of the manuscript. NKHdB and HJCB critically revised the manuscript. All authors approved the final version of the article, including the authorship list.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests NKHdB has served as a speaker for AbbVie and MSD and has served as consultant and principal investigator for TEVA Pharma BV and Takeda. He has received a (unrestricted) research grant from Dr Falk, TEVA Pharma BV, MLDS and Takeda.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.