Efficacy of 6-Mercaptopurine as Second-Line Treatment for Patients With Autoimmune Hepatitis and Azathioprine Intolerance.
OBJECTIVE
Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease that requires long-term immunosuppressive therapy. Although most patients have an excellent response to standard therapy (azathioprine in combination with corticosteroids), approximately 10%-15% have intolerance or an insufficient response to azathioprine treatment. We investigated whether 6-mercaptopurine (6-MP) is an effective second-line therapy for patients with AIH.


METHODS
We performed a retrospective study of 22 patients with AIH who were switched to 6-MP therapy after treatment with the combination of azathioprine and prednisolone at 2 tertiary care institutions in Europe (Germany and the United Kingdom) before November 15, 2014. We performed statistical analyses of data on clinical and biochemical responses collected 4 weeks after 6-MP treatment and then at regular physician visits.


RESULTS
A total of 15 of 20 patients with prior azathioprine intolerance (75%) responded to 6-MP treatment; 8 of these patients had a complete response and 7 had partial remission, based on biochemical features. In these 15 patients, 6-MP was well tolerated, whereas the 5 remaining patients had to be switched to different immunosuppressive regimes because of 6-MP intolerance. The 2 patients with insufficient response to azathioprine treatment also showed no response to 6-MP.


CONCLUSIONS
In patients with AIH and azathioprine intolerance, 6-MP seems to be an effective and well-tolerated second-line treatment. 6-MP might be ineffective in patients with insufficient response to azathioprine.
Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Sina
S
Hübener
Centre for Liver Research, University of Birmingham Liver Unit, Birmingham, United Kingdom.
Ye Htun
YH
Oo
Centre for Liver Research, University of Birmingham Liver Unit, Birmingham, United Kingdom.
Nwe Ni
NN
Than
Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Peter
P
Hübener
Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Christina
C
Weiler-Normann
Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Ansgar W
AW
Lohse
Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: cschramm@uke.de.
Christoph
C
Schramm
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005858:Germany; D019693:Hepatitis, Autoimmune / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D015122:Mercaptopurine / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult
D007166:Immunosuppressive Agents; D015122:Mercaptopurine
6-Mercaptopurine; Autoimmune Hepatitis; Azathioprine Intolerance; Second-Line Therapy