On tolerability and safety of a maintenance treatment with 6-thioguanine in azathioprineor 6-mercaptopurine intolerant IBD patients  

作　　者：Nanne KH de Boer Luc JJ Derijks Lennard PL Gilissen Daniel W Hommes Leopold GJB Engels Sybrand Y de Boer Gijsbertus den Hartog Piet M Hooymans Anja BU M(?)kelburg Barend D Westerveld Anton HJ Naber Chris JJ Mulder Dirk J de Jong 

机构地区：[1]Department of Gastroenterology and Hepatology VU University Medical Centre, Amsterdam, The Netherlands [2]Department of Clinical Pharmacy Maxima Medical Centre, Veldhoven, The Netherlands [3]Department of Gastroenterology and Hepatology Academic Hospital, Maastricht, The Netherlands [4]Department of Gastroenterology and Hepatology Academic Medical Centre, Amsterdam, The Netherlands [5]Department of Gastroenterology and Hepatology Maasland Hospital, Sittard, The Netherlands [6]Department of Gastroenterology and Hepatology Rijnstate Hospital, Arnhem, The Netherlands [7]Department of Clinical Pharmacy Maasland Hospital, Sittard, The Netherlands [8]Department of Gastroenterology and Hepatology Isala Clinics Location Sophia, Zwolle, The Netherlands [9]Department of Gastroenterology and Hepatology Radboud University Nijmegen Medical Centre, The Netherlands

出　　处：《World Journal of Gastroenterology》2005年第35期5540-5544,共5页世界胃肠病学杂志（英文版）

摘　　要：AIM: To determine the tolerability and safety profile of a low-dose maintenance therapy with 6-TG in azathioprine (AZA) or 6-mercaptopurine (6-MP) intolerant inflammatory bowel disease (IBD) patients over a treatment period of at least 1 year.METHODS: Database analysis.RESULTS: Twenty out of ninety-five (21%) patients discontinued 6-TG (mean dose 24.6 mg; mean 6-TGN level 540 pmol/8×108 RBC) within 1 year. Reasons for discontinuation were GI complaints (31%), malaise (15%)and hepatotoxicity (15%). Hematological events occurred in three patients, one discontinued treatment. In the 6-TG-tolerant group, 9% (7/75) could be classified as hepatotoxicity. An abdominal ultrasound was performed in 54% of patients, one patient had splenomegaly.CONCLUSION: The majority of AZA or 6-MP-intolerant IBD patients (79%) is able to tolerate maintenance treatment with 6-TG (dosages between 0.3 and 0.4 mg/kg per d). 6-TG may still be considered as an escape maintenance immunosuppressant in this difficult to treat group of patients, taking into account potential toxicity and efficacy of other alternatives. The recently reported hepatotoxicity is worrisome and 6-TG should therefore be administered only in prospective trials.AIM： To determine the tolerability and safety profile of a low-dose maintenance therapy with 6-TG in azathioprine （AZA） or 6-mercaptopurine （6-MP） intolerant inflammatory bowel disease （IBD） patients over a treatment period of at least 1 year. METHODS： Database analysis. RESULTS： Twenty out of ninety-five （21%） patients discontinued 6-TG （mean dose 24.6 mg; mean 6-TGN level 540 pmol/8×10^8 RBC） within 1 year. Reasons for discontinuation were GI complaints （31%）, malaise （15%） and hepatotoxicity （15%）. Hematological events occurred in three patients, one discontinued treatment. In the 6-TG-tolerant group, 9% （7/75） could be classified as hepatotoxicity. An abdominal ultrasound was performed in 54% of patients, one patient had splenomegaly. CONCLUSION： The majority of AZA or 6-MP-intolerantIBD patients （79%） is able to tolerate maintenance treatment with 6-TG （dosages between 0.3 and 0.4 mg/kg per d）. 6-TG may still be considered as an escape maintenance immunosuppressant in this difficult to treat group of patients, taking into account potential toxicity and efficacy of other alternatives. The recently reported hepatotoxicity is worrisome and 6-TG should therefore be administered only in prospective trials.

关 键 词：6-THIOGUANINE AZATHIOPRINE 6-MERCAPTOPURINE Crohn＇s disease Ulcerative colitis Side effects Tolerance SAFETY 

分 类 号：R574.62[医药卫生—消化系统]