Pulse Dosing of Thioguanine in Recalcitrant Psoriasis

A Delphi Consensus Approach to Challenging Case Scenarios in Moderate-to-Severe Psoriasis: Part 2

“…Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels also may increase, although these elevations do not correlate with chronic liver disease. Pulse dosing has similar efficacy to daily dosing, but may lower the risk of adverse events (grade B evidence) [17]. …”

6-Thioguanine in the Treatment of Psoriasis: A Case Report and Literature Review

“…In contrast, 6-thioguanine is metabolized in the liver and is not nephrotoxic. 1,5,7 6-Thioguanine is similar to 6-mercaptopurine and acts as an antimetabolite to inhibit DNA synthesis, presumably by inhibition of purine ring synthesis. Still, it is unlikely that the doses of 6-thioguanine used in psoriasis directly influence growth of keratinocytes to produce clinical effects.…”

Purine Synthesis Inhibitors, 6-thioguanine and Azathioprine: Forgotten Treatment Options in Psoriasis and Psoriatic Arthritis

“…Silvis and Levine, in a study of 14 patients with recalcitrant plaque-type psoriasis treated with a pulse-dosing schedule of 120 mg twice weekly to 160 mg thrice weekly, noted marked improvement (≥75%) in 10 of the patients (71%). 27 One patient was lost to follow-up after initial positive response, and three patients failed to respond to therapy. Initial response was noticed within the first two to four weeks of treatment, and marked clearance was seen between 14 to 43 weeks of treatment, with a mean of 26 weeks.…”