Biochemical efficacy of tioguanine in autoimmune hepatitis: a retrospective review of practice in the Netherlands.

Autor: van den Brand FF; Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., van Nieuwkerk CMJ; Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., Verwer BJ; Department of Gastroenterology and Hepatology, Spaarne Gasthuis, Haarlem, The Netherlands., de Boer YS; Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., de Boer NKH; Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., Mulder CJJ; Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., Bloemena E; Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., Bakker CM; Department of Gastroenterology and Hepatology, Zuyderland Medical Center, Heerlen, The Netherlands., Vrolijk JM; Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands., Drenth JPH; Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands., Tan ACITL; Department of Gastroenterology and Hepatology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands., Ter Borg F; Department of Gastroenterology and Hepatology, Deventer Hospital, Deventer, The Netherlands., Ter Borg MJ; Department of Gastroenterology and Hepatology, Maxima Medical Center, Eindhoven, The Netherlands., van den Hazel SJ; Department of Gastroenterology and Hepatology, Slingeland Hospital, Doetinchem, The Netherlands., Inderson A; Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands., Tushuizen ME; Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands., Bouma G; Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Jazyk: angličtina
Zdroj: Alimentary pharmacology & therapeutics [Aliment Pharmacol Ther] 2018 Oct; Vol. 48 (7), pp. 761-767. Date of Electronic Publication: 2018 Aug 15.
DOI: 10.1111/apt.14939
Abstrakt: Background: Azathioprine (AZA) and mercaptopurine (MP) are the cornerstone of steroid-sparing strategies in autoimmune hepatitis (AIH). Up to 20% of patients do not tolerate or respond to these regimens.
Aim: To evaluate retrospectively the tolerability and efficacy of tioguanine (thioguanine) (TG) therapy in selected patients with AIH and AIH variant syndromes.
Methods: Records of 52 patients who received TG therapy were retrieved from nine hospitals in the Netherlands. Indications for TG treatment were intolerable side effects on AZA or MP (n = 38), insufficient response (n = 11) or first-line treatment (n = 3). Treatment efficacy was defined as normalisation of serum aminotransferases and serum immunoglobulin G.
Results: No serious adverse events occurred in patients treated with TG during a median follow-up of 18 months (range 1-194). Treatment was well tolerated in 41 patients (79%), whereas four had tolerable (8%) and seven (13%) intolerable side effects. Thirty-eight patients were treated with TG after intolerable side effects on AZA or MP; 29 patients continued TG therapy of whom 24 (83%) achieved complete biochemical remission, four (14%) had incomplete and one (3%) had no response; nine discontinued treatment. Seven of 11 patients with insufficient response to AZA or MP were responsive to TG, three with complete and four with incomplete biochemical remission; four discontinued due to intolerance (n = 2) and non-response (n = 2). TG was effective in all AIH patients as first-line maintenance treatment.
Conclusion: In our retrospective review of TG therapy in selected patients with AIH or AIH variants who previously failed on AZA or MP, TG appeared tolerable with biochemical efficacy.
(© 2018 The Authors. Alimentary Pharmacology & Therapeutics Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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