Histological remission of autoimmune hepatitis after the addition of allopurinol and azathioprine dose reduction
| Autor: | Adriana Ribas Andrade, Suzane Kioko Ono, Ana Luiza Vilar Guedes, Debora Raquel Benedita Terrabuio, Fabiana Roberto Lima, Eduardo Luiz Rachid Cançado, Vinicius Santos Nunes, Evandro Sobroza de Mello |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
0301 basic medicine
lcsh:Internal medicine Metabolite Allopurinol lcsh:Medicine Azathioprine Autoimmune hepatitis Pathology and Forensic Medicine Hepatitis 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Internal Medicine Medicine lcsh:RC31-1245 Immunosuppressive effect Thiopurine methyltransferase biology business.industry lcsh:R Inflammatory Bowel Diseases medicine.disease Article / Clinical Case Report Hepatitis Autoimmune 030104 developmental biology chemistry Immunology biology.protein Azathioprine Metabolism 030211 gastroenterology & hepatology Dose reduction business medicine.drug Autoimmune |
| Zdroj: | Autopsy and Case Reports, Vol 7, Iss 2 (2017) Autopsy & Case Reports |
| ISSN: | 2236-1960 |
| Popis: | The standard therapy for some autoimmune diseases consists of a combination of corticosteroids and thiopurines. In non-responders to thiopurine drugs, the measurement of the metabolites of azathioprine, 6-thioguanine, and 6-methylmercaptopurine, can be a useful tool. The measurement has been used during the treatment of inflammatory bowel diseases and, less commonly, in autoimmune hepatitis. Many patients preferentially metabolize thiopurines to 6-methylmercaptopurine (6-MMP), which is potentially hepatotoxic, instead of 6-thioguanine, the active immunosuppressive metabolite. The addition of allopurinol shifts the metabolism of thiopurine towards 6-thioguanine, improving the immunosuppressive effect. We present the case of a 51-year-old female with autoimmune hepatitis who had a biochemical response after azathioprine and prednisone treatment without histological remission, and who preferentially shunted to 6-MMP. After the addition of allopurinol, the patient’s 6-thioguanine levels increased, and she reached histological remission with a reduction of 67% of the original dose of azathioprine. The patient did not develop clinical manifestations as a consequence of her increased immunosuppressive state. We also review the relevant literature related to this issue. In conclusion, the addition of allopurinol to thiopurine seems to be an option for those patients who do not reach histological remission and who have a skewed thiopurine metabolite profile. |
| Databáze: | OpenAIRE |
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