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

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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 languageEnglish
Pages (from-to)5540-5544
JournalWorld Journal of Gastroenterology
Volume11
Issue number35
DOIs
Publication statusPublished - 1 Jan 2005

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