Biochemical efficacy of tioguanine in autoimmune hepatitis: a retrospective review of practice in the Netherlands

• Published in: Alimentary pharmacology & therapeutics Vol. 48; no. 7; pp. 761 - 767
• Main Authors: Brand, Floris F., Nieuwkerk, Carin M. J., Verwer, Bart J., Boer, Ynto S., Boer, Nanne K. H., Mulder, Chris J. J., Bloemena, Elisabeth, Bakker, Christine M., Vrolijk, Jan M., Drenth, Joost P. H., Tan, Adriaan C. I. T. L., Borg, Frank, Borg, Martijn J., Hazel, Sven J., Inderson, Akin, Tushuizen, Maarten E., Bouma, Gerd
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.10.2018; John Wiley and Sons Inc
• Subjects: 6-Mercaptopurine; Adolescent; Adult; Aged; Azathioprine; Azathioprine - therapeutic use; Biochemistry; Biomarkers - analysis; Child; Drug-Related Side Effects and Adverse Reactions - epidemiology; Female; Hepatitis; Hepatitis, Autoimmune - drug therapy; Hepatitis, Autoimmune - epidemiology; Humans; Immunoglobulin G; Immunosuppressive Agents - therapeutic use; Intolerance; Male; Mercaptopurine - therapeutic use; Middle Aged; Netherlands - epidemiology; Original; Patients; Remission; Remission Induction; Retrospective Studies; Side effects; Thioguanine; Thioguanine - therapeutic use; Tioguanine in Autoimmune Hepatitis; Treatment Outcome; Young Adult; Netherlands
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/apt.14939

Summary Background Azathioprine (AZA) and mercaptopurine (MP) are the cornerstone of steroid‐sparing strategies in autoimmune hepatitis (AIH). Up to 20% of patients do not tolerate or respond to these regimens. Aim To evaluate retrospectively the tolerability and efficacy of tioguanine (thioguanine) (TG) therapy in selected patients with AIH and AIH variant syndromes. Methods Records of 52 patients who received TG therapy were retrieved from nine hospitals in the Netherlands. Indications for TG treatment were intolerable side effects on AZA or MP (n = 38), insufficient response (n = 11) or first‐line treatment (n = 3). Treatment efficacy was defined as normalisation of serum aminotransferases and serum immunoglobulin G. Results No serious adverse events occurred in patients treated with TG during a median follow‐up of 18 months (range 1‐194). Treatment was well tolerated in 41 patients (79%), whereas four had tolerable (8%) and seven (13%) intolerable side effects. Thirty‐eight patients were treated with TG after intolerable side effects on AZA or MP; 29 patients continued TG therapy of whom 24 (83%) achieved complete biochemical remission, four (14%) had incomplete and one (3%) had no response; nine discontinued treatment. Seven of 11 patients with insufficient response to AZA or MP were responsive to TG, three with complete and four with incomplete biochemical remission; four discontinued due to intolerance (n = 2) and non‐response (n = 2). TG was effective in all AIH patients as first‐line maintenance treatment. Conclusion In our retrospective review of TG therapy in selected patients with AIH or AIH variants who previously failed on AZA or MP, TG appeared tolerable with biochemical efficacy.