Promising treatment of autoimmune hepatitis with 6-thioguanine after adverse events on azathioprine

Eur J Gastroenterol Hepatol. 2005 Apr;17(4):457-61. doi: 10.1097/00042737-200504000-00012.

Abstract

The use of corticosteroids in autoimmune hepatitis is an established therapy. To avoid the possible serious side effects of corticosteroids, immunosuppression with azathioprine is often warranted. Azathioprine, a purine analogue, is frequently used to taper or replace corticosteroids. However, approximately 10% of the patients are intolerant to azathioprine. Alternative therapies using mycophenolate, tacrolimus, budesonide, cyclosporine and 6-mercaptopurine have been studied, with variable results. The use of 6-thioguanine, an agent more directly leading to the down-stream active metabolites of azathioprine (6-thioguanine nucleotides) in inflammatory bowel disease patients intolerant to azathioprine or 6-mercaptopurine showed conflicting results. We report three patients with autoimmune hepatitis who could not tolerate azathioprine but tolerated 6-thioguanine 0.3 milligram per kilogram daily well. All three patients improved clinically. Therapeutic drug monitoring was performed. The prospective evaluation of 6-thioguanine as a possible immunosuppressive drug in autoimmune hepatitis patients is warranted.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Aged
  • Aged, 80 and over
  • Azathioprine / adverse effects*
  • Azathioprine / therapeutic use
  • Female
  • Hepatitis, Autoimmune / drug therapy*
  • Humans
  • Immunosuppressive Agents / adverse effects*
  • Immunosuppressive Agents / therapeutic use
  • Liver Function Tests
  • Male
  • Middle Aged
  • Prednisone / therapeutic use
  • Thioguanine / therapeutic use*

Substances

  • Immunosuppressive Agents
  • Thioguanine
  • Azathioprine
  • Prednisone