PMID- 28588888
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20191120
IS  - 2050-6406 (Print)
IS  - 2050-6414 (Electronic)
IS  - 2050-6406 (Linking)
VI  - 5
IP  - 4
DP  - 2017 Jun
TI  - Thioguanine in inflammatory bowel disease: Long-term efficacy and safety.
PG  - 563-570
LID - 10.1177/2050640616663438 [doi]
AB  - BACKGROUND: Thioguanine (TG) is efficacious in inflammatory bowel disease (IBD), 
      but its toxicity, particularly nodular regenerative hyperplasia (NRH) of the 
      liver, has limited its use. We assessed the long-term clinical outcomes and 
      safety of TG in patients whom were intolerant or refractory to conventional 
      immunomodulators. METHODS: This is a retrospective, single-centre study of IBD 
      patients treated with TG from 2001-2013. Response was defined as clinical 
      remission (Harvey-Bradshaw Index < 5 for Crohn's disease (CD), Simple Clinical 
      Colitis Activity Index < 4 for ulcerative colitis (UC)) without corticosteroids 
      or, if receiving anti-tumour-necrosis-factor (anti-TNF) therapy, absence of dose 
      escalation. We recorded TG failure, withdrawal and adverse events. Patients were 
      monitored with biochemistry, liver biopsy and/or magnetic resonance imaging 
      (MRI). RESULTS: 54 patients (47 CD and 7 UC) whom received TG (mean dose: 27 mg/d 
      (range: 20-40 mg/d)) as monotherapy (n = 36) or concomitantly with anti-TNF 
      (n = 18) for a median inter-quartile range of 16 (5-37) months (126 patient-years 
      of follow-up). 32 (59%) patients responded to TG at 6 months and 23 (43%) at 12 
      months. Pancreatitis did not recur amongst the 19 patients with prior 
      thiopurine-induced pancreatitis. 16 (30%) patients ceased TG due to intolerance 
      or toxicity (four serious); NRH was not observed. 6-thioguanine nucleotide 
      concentrations did not correlate with efficacy nor with toxicity. CONCLUSIONS: TG 
      was efficacious and well tolerated in one out of two patients who had previously 
      failed conventional immunomodulators. NRH did not occur.
FAU - Ward, Mark G
AU  - Ward MG
AD  - Department of Gastroenterology, Guy's and St. Thomas' Hospital, NHS Foundation 
      Trust, London, UK.
FAU - Patel, Kamal V
AU  - Patel KV
AD  - Department of Gastroenterology, Guy's and St. Thomas' Hospital, NHS Foundation 
      Trust, London, UK.
FAU - Kariyawasam, Viraj C
AU  - Kariyawasam VC
AD  - Department of Gastroenterology, Guy's and St. Thomas' Hospital, NHS Foundation 
      Trust, London, UK.
FAU - Goel, Rishi
AU  - Goel R
AD  - Department of Gastroenterology, Guy's and St. Thomas' Hospital, NHS Foundation 
      Trust, London, UK.
FAU - Warner, Ben
AU  - Warner B
AD  - Department of Gastroenterology, Guy's and St. Thomas' Hospital, NHS Foundation 
      Trust, London, UK.
FAU - Elliott, Tim R
AU  - Elliott TR
AD  - Department of Gastroenterology, Guy's and St. Thomas' Hospital, NHS Foundation 
      Trust, London, UK.
FAU - Blaker, Paul A
AU  - Blaker PA
AD  - Department of Gastroenterology, Guy's and St. Thomas' Hospital, NHS Foundation 
      Trust, London, UK.
FAU - Irving, Peter M
AU  - Irving PM
AD  - Department of Gastroenterology, Guy's and St. Thomas' Hospital, NHS Foundation 
      Trust, London, UK.
AD  - Diabetes and Nutritional Sciences Division, School of Medicine, King's College 
      London, London, UK.
FAU - Marinaki, Anthony M
AU  - Marinaki AM
AD  - Purine Research Laboratory, Viapath, Guy's and St. Thomas' Hospital, London, UK.
FAU - Sanderson, Jeremy D
AU  - Sanderson JD
AD  - Department of Gastroenterology, Guy's and St. Thomas' Hospital, NHS Foundation 
      Trust, London, UK.
AD  - Diabetes and Nutritional Sciences Division, School of Medicine, King's College 
      London, London, UK.
LA  - eng
PT  - Journal Article
DEP - 20160801
PL  - England
TA  - United European Gastroenterol J
JT  - United European gastroenterology journal
JID - 101606807
PMC - PMC5446138
OTO - NOTNLM
OT  - Crohn's disease
OT  - thioguanine
OT  - thiopurine
OT  - toxicity
OT  - ulcerative colitis
EDAT- 2017/06/08 06:00
MHDA- 2017/06/08 06:01
PMCR- 2017/06/01
CRDT- 2017/06/08 06:00
PHST- 2016/02/25 00:00 [received]
PHST- 2016/07/17 00:00 [accepted]
PHST- 2017/06/08 06:00 [entrez]
PHST- 2017/06/08 06:00 [pubmed]
PHST- 2017/06/08 06:01 [medline]
PHST- 2017/06/01 00:00 [pmc-release]
AID - 10.1177_2050640616663438 [pii]
AID - 10.1177/2050640616663438 [doi]
PST - ppublish
SO  - United European Gastroenterol J. 2017 Jun;5(4):563-570. doi: 
      10.1177/2050640616663438. Epub 2016 Aug 1.