title: Promising treatment of autoimmune hepatitis with 6-thioguanine after adverse events on azathioprine.
abstract: The use of corticosteroids in autoimmune hepatitis is an established therapy. To avoid the possible serious side effects of corticosteroids, immunosuppression with azathioprine is often warranted. Azathioprine, a purine analogue, is frequently used to taper or replace corticosteroids. However, approximately 10% of the patients are intolerant to azathioprine. Alternative therapies using mycophenolate, tacrolimus, budesonide, cyclosporine and 6-mercaptopurine have been studied, with variable results. The use of 6-thioguanine, an agent more directly leading to the down-stream active metabolites of azathioprine (6-thioguanine nucleotides) in inflammatory bowel disease patients intolerant to azathioprine or 6-mercaptopurine showed conflicting results. We report three patients with autoimmune hepatitis who could not tolerate azathioprine but tolerated 6-thioguanine 0.3 milligram per kilogram daily well. All three patients improved clinically. Therapeutic drug monitoring was performed. The prospective evaluation of 6-thioguanine as a possible immunosuppressive drug in autoimmune hepatitis patients is warranted.
authors.affiliation: Dept of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands. khn.deboer@vumc.nl
authors.forename: Nanne K H
authors.initials: NK
authors.lastname: de Boer
authors.forename: Carin M J
authors.initials: CM
authors.lastname: van Nieuwkerk
authors.forename: M Nieves
authors.initials: MN
authors.lastname: Aparicio Pages
authors.forename: Sybrand Y
authors.initials: SY
authors.lastname: de Boer
authors.forename: Luc J J
authors.initials: LJ
authors.lastname: Derijks
authors.forename: Chris J J
authors.initials: CJ
authors.lastname: Mulder
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001379:Azathioprine / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D019693:Hepatitis, Autoimmune / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D013866:Thioguanine / Q000627:therapeutic use*
chemical_list: D007166:Immunosuppressive Agents; D013866:Thioguanine; D001379:Azathioprine; D011241:Prednisone