On tolerability and safety of a maintenance treatment with 6-thioguanine in azathioprine or 6-mercaptopurine intolerant IBD patients

N.K. de Boer; L.J. Derijks; L.P. Gilissen; D.W. Hommes; L.G.B. Engels; S.Y. de Boer; G. den Hartog; P.M. Hooymans; A.B. Makelburg; B.D. Westerveld; A.H. Naber; C.J. Mulder; D.J. de Jong

doi:10.3748/wjg.v11.i35.5540

On tolerability and safety of a maintenance treatment with 6-thioguanine in azathioprine or 6-mercaptopurine intolerant IBD patients

N.K. de Boer, L.J. Derijks, L.P. Gilissen, D.W. Hommes, L.G.B. Engels, S.Y. de Boer, G. den Hartog, P.M. Hooymans, A.B. Makelburg, B.D. Westerveld, A.H. Naber, C.J. Mulder^*, D.J. de Jong

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

AIM: To determine the tolerability and safety profile of a low-dose maintenance therapy with 6-TG in azathioprine (AZA) or 6-mercaptopurine (6-MP) intolerant inflammatory bowel disease (IBD) patients over a treatment period of at least 1 year. METHODS: Database analysis. RESULTS: Twenty out of ninety-five (21%) patients discontinued 6-TG (mean dose 24.6 mg; mean 6-TGN level 540 pmol/8 x 10(8) RBC) within 1 year. Reasons for discontinuation were GI complaints (31%), malaise (15%) and hepatotoxicity (15%). Hematological events occurred in three patients, one discontinued treatment. In the 6-TG-tolerant group, 9% (7/75) could be classified as hepatotoxicity. An abdominal ultrasound was performed in 54% of patients, one patient had splenomegaly. CONCLUSION: The majority of AZA or 6-MP-intolerant IBD patients (79%) is able to tolerate maintenance treatment with 6-TG (dosages between 0.3 and 0.4 mg/kg per d). 6-TG may still be considered as an escape maintenance immunosuppressant in this difficult to treat group of patients, taking into account potential toxicity and efficacy of other alternatives. The recently reported hepatotoxicity is worrisome and 6-TG should therefore be administered only in prospective trials.

Original language	English
Pages (from-to)	5540-5544
Journal	World Journal of Gastroenterology
Volume	11
Issue number	35
DOIs	https://doi.org/10.3748/wjg.v11.i35.5540
Publication status	Published - 1 Jan 2005

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Cite this

de Boer, N. K., Derijks, L. J., Gilissen, L. P., Hommes, D. W., Engels, L. G. B., de Boer, S. Y., den Hartog, G., Hooymans, P. M., Makelburg, A. B., Westerveld, B. D., Naber, A. H., Mulder, C. J., & de Jong, D. J. (2005). On tolerability and safety of a maintenance treatment with 6-thioguanine in azathioprine or 6-mercaptopurine intolerant IBD patients. World Journal of Gastroenterology, 11(35), 5540-5544. https://doi.org/10.3748/wjg.v11.i35.5540

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title = "On tolerability and safety of a maintenance treatment with 6-thioguanine in azathioprine or 6-mercaptopurine intolerant IBD patients",

abstract = "AIM: To determine the tolerability and safety profile of a low-dose maintenance therapy with 6-TG in azathioprine (AZA) or 6-mercaptopurine (6-MP) intolerant inflammatory bowel disease (IBD) patients over a treatment period of at least 1 year. METHODS: Database analysis. RESULTS: Twenty out of ninety-five (21%) patients discontinued 6-TG (mean dose 24.6 mg; mean 6-TGN level 540 pmol/8 x 10(8) RBC) within 1 year. Reasons for discontinuation were GI complaints (31%), malaise (15%) and hepatotoxicity (15%). Hematological events occurred in three patients, one discontinued treatment. In the 6-TG-tolerant group, 9% (7/75) could be classified as hepatotoxicity. An abdominal ultrasound was performed in 54% of patients, one patient had splenomegaly. CONCLUSION: The majority of AZA or 6-MP-intolerant IBD patients (79%) is able to tolerate maintenance treatment with 6-TG (dosages between 0.3 and 0.4 mg/kg per d). 6-TG may still be considered as an escape maintenance immunosuppressant in this difficult to treat group of patients, taking into account potential toxicity and efficacy of other alternatives. The recently reported hepatotoxicity is worrisome and 6-TG should therefore be administered only in prospective trials.",

author = "{de Boer}, N.K. and L.J. Derijks and L.P. Gilissen and D.W. Hommes and L.G.B. Engels and {de Boer}, S.Y. and {den Hartog}, G. and P.M. Hooymans and A.B. Makelburg and B.D. Westerveld and A.H. Naber and C.J. Mulder and {de Jong}, D.J.",

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de Boer, NK, Derijks, LJ, Gilissen, LP, Hommes, DW, Engels, LGB, de Boer, SY, den Hartog, G, Hooymans, PM, Makelburg, AB, Westerveld, BD, Naber, AH, Mulder, CJ & de Jong, DJ 2005, 'On tolerability and safety of a maintenance treatment with 6-thioguanine in azathioprine or 6-mercaptopurine intolerant IBD patients', World Journal of Gastroenterology, vol. 11, no. 35, pp. 5540-5544. https://doi.org/10.3748/wjg.v11.i35.5540

TY - JOUR

T1 - On tolerability and safety of a maintenance treatment with 6-thioguanine in azathioprine or 6-mercaptopurine intolerant IBD patients

AU - de Boer, N.K.

AU - Derijks, L.J.

AU - Gilissen, L.P.

AU - Hommes, D.W.

AU - Engels, L.G.B.

AU - de Boer, S.Y.

AU - den Hartog, G.

AU - Hooymans, P.M.

AU - Makelburg, A.B.

AU - Westerveld, B.D.

AU - Naber, A.H.

AU - Mulder, C.J.

AU - de Jong, D.J.

PY - 2005/1/1

Y1 - 2005/1/1

N2 - AIM: To determine the tolerability and safety profile of a low-dose maintenance therapy with 6-TG in azathioprine (AZA) or 6-mercaptopurine (6-MP) intolerant inflammatory bowel disease (IBD) patients over a treatment period of at least 1 year. METHODS: Database analysis. RESULTS: Twenty out of ninety-five (21%) patients discontinued 6-TG (mean dose 24.6 mg; mean 6-TGN level 540 pmol/8 x 10(8) RBC) within 1 year. Reasons for discontinuation were GI complaints (31%), malaise (15%) and hepatotoxicity (15%). Hematological events occurred in three patients, one discontinued treatment. In the 6-TG-tolerant group, 9% (7/75) could be classified as hepatotoxicity. An abdominal ultrasound was performed in 54% of patients, one patient had splenomegaly. CONCLUSION: The majority of AZA or 6-MP-intolerant IBD patients (79%) is able to tolerate maintenance treatment with 6-TG (dosages between 0.3 and 0.4 mg/kg per d). 6-TG may still be considered as an escape maintenance immunosuppressant in this difficult to treat group of patients, taking into account potential toxicity and efficacy of other alternatives. The recently reported hepatotoxicity is worrisome and 6-TG should therefore be administered only in prospective trials.

AB - AIM: To determine the tolerability and safety profile of a low-dose maintenance therapy with 6-TG in azathioprine (AZA) or 6-mercaptopurine (6-MP) intolerant inflammatory bowel disease (IBD) patients over a treatment period of at least 1 year. METHODS: Database analysis. RESULTS: Twenty out of ninety-five (21%) patients discontinued 6-TG (mean dose 24.6 mg; mean 6-TGN level 540 pmol/8 x 10(8) RBC) within 1 year. Reasons for discontinuation were GI complaints (31%), malaise (15%) and hepatotoxicity (15%). Hematological events occurred in three patients, one discontinued treatment. In the 6-TG-tolerant group, 9% (7/75) could be classified as hepatotoxicity. An abdominal ultrasound was performed in 54% of patients, one patient had splenomegaly. CONCLUSION: The majority of AZA or 6-MP-intolerant IBD patients (79%) is able to tolerate maintenance treatment with 6-TG (dosages between 0.3 and 0.4 mg/kg per d). 6-TG may still be considered as an escape maintenance immunosuppressant in this difficult to treat group of patients, taking into account potential toxicity and efficacy of other alternatives. The recently reported hepatotoxicity is worrisome and 6-TG should therefore be administered only in prospective trials.

U2 - 10.3748/wjg.v11.i35.5540

DO - 10.3748/wjg.v11.i35.5540

M3 - Article

SN - 1007-9327

VL - 11

SP - 5540

EP - 5544

JO - World Journal of Gastroenterology

JF - World Journal of Gastroenterology

IS - 35

ER -