title: Allopurinol: a useful adjunct to thiopurine therapy for pediatric ulcerative colitis in the biologic era.
abstract: Thiopurines are used as a maintenance therapy in patients with ulcerative colitis (UC). For some patients the metabolism of thiopurines is unfavorable, leading to increased adverse effects, including hepatotoxicity. There are many reports in the adult literature concerning the manipulation of thiopurine metabolism with allopurinol; however, there is only 1 publication in this respect for pediatric UC. We present 3 pediatric cases of UC wherein the combination of allopurinol and low-dose 6-mercaptopurine allowed for shunting of thiopurine metabolites to a more favorable pattern. This intervention supported clinical remission in all, including one case poorly responsive to infliximab.
authors.affiliation: Section of Pediatric Gastroenterology, Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, Texas Children's Hospital, Houston, TX.
authors.forename: Faith D
authors.initials: FD
authors.lastname: Ihekweazu
authors.forename: Richard
authors.initials: R
authors.lastname: Kellermayer
mesh_terms: D000293:Adolescent; D000493:Allopurinol / Q000627:therapeutic use*; D000963:Antimetabolites / Q000627:therapeutic use*; D002648:Child; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D006150:Guanine Nucleotides / Q000097:blood; D006801:Humans; D007166:Immunosuppressive Agents / Q000378:metabolism* / Q000627:therapeutic use*; D008297:Male; D015122:Mercaptopurine / Q000031:analogs & derivatives / Q000097:blood / Q000378:metabolism / Q000627:therapeutic use*; D013873:Thionucleotides / Q000097:blood
chemical_list: D000963:Antimetabolites; D006150:Guanine Nucleotides; D007166:Immunosuppressive Agents; D013873:Thionucleotides; C003964:6-thioguanylic acid; D000493:Allopurinol; C010240:6-methylthiopurine; D015122:Mercaptopurine