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

Digestion - Tập 73 Số 1 - Trang 25-31 - 2006
Nanne K.H. de Boer1, Walter Reinisch2, Alexander Teml2, Ad A. van Bodegraven1, Matthias Schwab3, Milan Lukáš4, Thomas Ochsenkühn5, W Petritsch6, P Knoflach7, Sven Almér8, Van der Merwe9, Klaus Herrlinger10, Julia Seiderer5, Harald Vogelsang2, Chris J. Mulder1
1Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands (representing the Dutch 6-TG working group)
2Gastroenterology and Hepatology, Medical University Vienna, Vienna, Austria
3Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany
4Gastroenterology and Hepatology, Charles University, Prague, Czech Republic
5Gastroenterology and Hepatology, University Hospital Munich, Munich, Germany
6Gastroenterology and Hepatology, Medical University Graz, Graz, Austria
7Internal Medicine, Hospital of the Barmherzigen Schwestern, Wels, Austria
8Gastroenterology and Hepatology/IMK, Clinical Pharmacology/IMV, Linköping University, Linköping, Sweden
9Gastroenterology, Unitas Hospital, Pretoria, South Africa
10Internal Medicine 1, Robert Bosch Krankenhaus, Stuttgart, Germany

Tóm tắt

Recently, the suggestion to use 6-thioguanine (6-TG) as an alternative thiopurine in patients with inflammatory bowel disease (IBD) has been discarded due to reports about possible (hepato) toxicity. During meetings arranged in Vienna and Prague in 2004, European experts applying 6-TG further on in IBD patients presented data on safety and efficacy of 6-TG. After thorough evaluation of its risk-benefit ratio, the group consented that 6-TG may still be considered as a rescue drug in stringently defined indications in IBD, albeit restricted to a clinical research setting. As a potential indication for administering 6-TG, we delineated the requirement for maintenance therapy as well as intolerance and/or resistance to aminosalicylates, azathioprine, 6-mercaptopurine, methotrexate and infliximab. Furthermore, indications are preferred in which surgery is thought to be inappropriate. The standard 6-TG dosage should not exceed 25 mg daily. Routine laboratory controls are mandatory in short intervals. Liver biopsies should be performed after 6–12 months, three years and then three-yearly accompanied by gastroduodenoscopy, to monitor for potential hepatotoxicity, including nodular regenerative hyperplasia (NRH) and veno-occlusive disease (VOD). Treatment with 6-TG must be discontinued in case of overt or histologically proven hepatotoxicity.

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Tài liệu tham khảo

10.1136%2Fgut.2004.043372

10.1053%2Fj.gastro.2003.11.014

10.1016%2FS0140-6736%2802%2908512-4

10.1053%2Fj.gastro.2003.11.014

10.1016%2Fj.dld.2004.09.029

10.1053%2Fj.gastro.2005.01.010

10.1053%2FS0016-5085%2804%2902021-9

10.1136%2Fgut.49.6.874a

10.1016%2FS0016-5085%2803%2900938-7

10.1172%2FJCI200316432

10.1097%2F01.fpc.0000114745.08559.db

10.1016%2FS0016-5085%2800%2970354-4

10.1097%2F00043426-200009000-00011

10.1016%2FS0016-5085%2800%2970140-5

10.1097%2F00008571-200403000-00006

10.1097%2F00008571-200411000-00010

10.1136%2Fbmj.1.5495.1081

10.1097%2F00054725-200108000-00001

10.1046%2Fj.1365-2036.2003.01440.x

10.1046%2Fj.1365-2036.2003.01590.x

10.1046%2Fj.1365-2036.2003.01683.x

10.1097%2F00042737-200301000-00011

10.1111%2Fj.1572-0241.2003.07413.x

10.1080%2F00365520510023369

10.1097%2F00042737-200103000-00013

10.1016%2F0168-8278%2891%2990916-Y

10.1016%2FS0399-8320%2805%2982136-0

10.1136%2Fpgmj.64.758.950

10.1016%2F0270-9139%2894%2990138-4

10.1016%2Fj.jhep.2005.02.051

10.1002%2Flt.20554

10.1111%2Fj.1365-2036.2004.01947.x

10.1002%2F1097-0142%28197709%2940%3A3%3C1300%3A%3AAID-CNCR2820400345%3E3.0.CO%3B2-9

10.1080%2F00365520510024089

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Digestion

Tập 73 Số 1

25-31

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