6-Thioguanine Treatment in Inflammatory Bowel Disease: A Critical Appraisal by a European 6-TG Working Party

Boer, Nanne K. H. de; Reinisch, Walter; Teml, Alexander; Bodegraven, Ad A. van; Schwab, Matthias; Lukáš, Milan; Ochsenkühn, Thomas; Petritsch, Wolfgang; Knoflach, P; Almér, Sven; Merwe, Schalk van der; Herrlinger, Klaus; Seiderer, Julia; Vogelsang, Harald; Mulder, Chris J.

doi:10.1159/000091662

Cited by 63 publications

(57 citation statements)

References 75 publications

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“…ioguanine, as an alternative to azathioprine or 6-mercaptopurine, has been used in some series with successful management in patients with allergic reactions or intolerance to azathioprine / 6-mercaptopurine (135,136) . However, there is a risk of nodular regenerative hyperplasia or venoocclusive disease of the liver (137) that may be related to increased levels of thioguanine nucleotides (135) .…”

Section: Moderate To Severe Diseasementioning

confidence: 99%

“…However, there is a risk of nodular regenerative hyperplasia or venoocclusive disease of the liver (137) that may be related to increased levels of thioguanine nucleotides (135) . At the present time, there are insu cient data to predict the risks of hepatotoxicity in CD patients and therapy with thioguanine cannot be recommended.…”

Section: Moderate To Severe Diseasementioning

confidence: 99%

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Management of Crohn's Disease in Adults

2009

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Guidelines for clinical practice are intended to suggest preferable approaches to particular medical problems as established by interpretation and collation of scientifi cally valid research, derived from extensive review of published literature. When data that will withstand objective scrutiny are not available, a recommendation may be made based on a consensus of experts. Guidelines are intended to apply to the clinical situation for all physicians without regard to specialty. Guidelines are intended to be fl exible, not necessarily indicating the only acceptable approach, and should be distinguished from standards of care that are infl exible and rarely violated. Given the wide range of choices in any health-care problem, the physician should select the course best suited to the individual patient and the clinical situation presented. These guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee. Expert opinion is solicited from the outset for the document. The quality of evidence upon which a specifi c recommendation is based is as follows: Grade A: Homogeneous evidence from multiple well-designed randomized (therapeutic) or cohort (descriptive) controlled trials, each involving a number of participants to be of suffi cient statistical power. Grade B: Evidence from at least one large well-designed clinical trial with or without randomization, from cohort or case -control analytic studies, or well-designed meta-analysis. Grade C: Evidence based on clinical experience, descriptive studies, or reports of expert committees. The Committee reviews guidelines in depth, with participation from experienced clinicians and others in related fi elds. The fi nal recommendations are based on the data available at the time of the production of the document and may be updated with pertinent scientifi c developments at a later time.

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Section: Moderate To Severe Diseasementioning

confidence: 99%

Section: Moderate To Severe Diseasementioning

confidence: 99%

Management of Crohn's Disease in Adults

2009

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“…The need for follow-up may be more frequent in cases of 6-TG usage. De Boer et al have recommended a liver biopsy after 6-12 months of therapy, and every three years thereafter for patients on 6-TG [67] . They also recommend EGD to screen for varices if clinically apparent portal hypertension from NRH is suspected.…”

Section: Drug-induced Liver Injury Due To Agents Used Tomentioning

confidence: 99%

Hepatotoxicity of Agents Used in the Management of Inflammatory Bowel Disease

Khokhar

Lewis²

2010

Dig Dis

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Patients with inflammatory bowel disease (IBD) are at risk for hepatobiliary disease and toxicity, and the diagnosis of drug-induced liver disease in patients being treated for IBD can represent a clinical challenge. There are a number of disease states associated with IBD, which are primary sclerosing cholangitis, cholangiocarcinoma and autoimmune hepatitis. There is a wide spectrum of hepatic injury that can occur from the agents used to treat IBD, such as acute or chronic hepatic injury directly attributable to the drugs used to treat IBD (e.g. sulfasalazine, mesalamine, thiopurines, methotrexate, TNF antagonists, quinolone antibiotics); liver toxicity from drugs used to treat complications of immunomodulators and TNF antagonists (e.g. isoniazid for treatment of reactivation tuberculosis), and exacerbation of underlying chronic viral hepatitis with infliximab and other TNF antagonists. Thiopurines are also associated with the development of hepatic vascular lesions, such as nodular regenerative hyperplasia and peliosis hepatic. In addition, biologics can be associated with the reactivation of underlying chronic viral hepatitis, mandating universal screening prior to initiation of TNF-alpha antagonist therapy.

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“…5 The European 6-TG working group recently recommended that 6-TG should be administered in a standard dose, not exceeding 25 mg/day. 6 In our patient concomitant hepatitis C infection could have been an influencing cofactor in developing portal hypertension.…”

Section: Variceal Hemorrhage In a Patient With Ulcerative Colitis Trementioning

confidence: 61%