Background: The need for immune suppressive strategies in the control of chronic inflammatory
bowel diseases originated in the 1960s following the perception of a relative inefficacy of
salazopyrin and its derivatives. In some 50 years upon an anecdotal claim, the indication for thiopurines
in the management of inflammatory bowel diseases has come of age.
Objective: The aim of this minireview is to give an overview, after the historical premises, of the current
use of thiopurines in the context of inflammatory bowel diseases.
Method: Through MEDLINE searches, we reviewed the literature of the last two decades.
Results: For Crohn’s disease, the 1980 trial of 6-mercaptopurine for steroid sparing and fistula closure
proved pivotal. The analysis of withdrawal experiments and of numerous open trials has established
the efficacy of thiopurines for ulcerative colitis. In this indication, cutting-edge data are now showing
that because targeting dysplasia, thiopurines can induce mucosal/histological healing, thus abolishing
or delaying the need for pre-emptive (tumor prophylactic) colectomy.
Conclusion: In UC thiopurines may be recognized to effect a treat-to-target strategy, joining the modern
algorithms of rheumatologic disorders.