Prolonged thioguanine therapy is well tolerated and safe in the treatment of ulcerative colitis.
BACKGROUND
Thioguanine has been used for the treatment of inflammatory bowel disease, in particular for patients who failed conventional thiopurine therapy. To date, thioguanine has been infrequently studied in ulcerative colitis.


OBJECTIVE
To evaluate the tolerability, safety and efficacy of thioguanine in the treatment of ulcerative colitis.


METHODS
A database analysis was performed on inflammatory bowel disease patients who had failed conventional thiopurine therapy and were treated with thioguanine. Rates and reasons for treatment failure were assessed. Laboratory values, abdominal ultrasonography, liver biopsy and endoscopic remission rates were evaluated.


RESULTS
Forty-six patients were included and median treatment duration was 22 months (range 0.3-72.0). Nine patients failed thioguanine therapy: six due to adverse events, three due to therapy resistance. Concomitant treatment with aminosalicylates protected against thioguanine failure (hazard ratio (HR) 0.11, 95% CI 0.03-0.48). When performed, ultrasonography (n = 21) revealed no suspected therapy-related pathology in all but one patient, in whom hepatomegaly was observed. Liver histology (n = 12) predominantly revealed no abnormalities (n = 4) or non-specific regeneration (n = 4); none showed nodular regenerative hyperplasia. At follow-up, 40% of colonoscopies revealed endoscopic remission as compared with 10% at baseline (P = 0.180).


CONCLUSIONS
Long-term use of thioguanine appears to be well tolerated and relatively safe in ulcerative colitis patients who failed conventional thiopurine therapy.
van Asseldonk
Dirk P
DP
Department of Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands. d.vanasseldonk@vumc.nl
Jharap
Bindia
B
Kuik
Dirk J
DJ
de Boer
Nanne K H
NK
Westerveld
Barend D
BD
Russel
Maurice G V M
MG
Kubben
Frank J G M
FJ
van Bodegraven
Ad A
AA
Mulder
Chris J
CJ
D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000188:drug therapy*; D016208:Databases, Factual; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D016017:Odds Ratio; D013866:Thioguanine / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D005765:Gastrointestinal Agents; D013866:Thioguanine