Low 6-thioguanine nucleotide level: Effective in maintaining remission in Chinese patients with Crohn's disease
Low 6-thioguanine nucleotide level: Effective in maintaining remission in Chinese patients with Crohn's disease
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低6-硫鸟嘌呤核苷酸水平：有效维持中国克罗恩病患者的缓解
DOI：
10.1111/jgh.14465
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发表时间：
2019
影响因子：
4.1
通讯作者：
Mao Ren
中科院分区：
文献类型：
--
作者：
Feng Rui;Guo Jing;Zhang Sheng hong;Qiu Yun;Chen Bai li;He Yao;Zeng Zhi rong;Ben Horin Shomron;Chen Min hu;Mao Ren
背景与目的测定6-硫代鸟嘌呤核苷酸(6-TGN)水平有助于优化硫唑嘌呤(AZA)的给药剂量和监测其毒性。与高加索克隆氏病(CD)患者相比，亚洲患者建议使用较低剂量的AZA来维持临床缓解。然而，亚洲患者所需的最佳6-TGN阈值尚未确定。因此，本研究的目的是探索亚洲CD患者维持临床缓解所需的最佳6-TGN阈值。方法在一个第三转诊中心进行了一项回顾性队列研究，招募了252名CD患者。主要终点是疾病复发。比较缓解组和复发组的6-TGN和AZA剂量。结果6-TGN水平在0~180.94之间，6-TGN浓度在8×108时，缓解率明显低于6-TGN浓度在180.94~255.50之间的患者(P=0.020)。四分位分析表明，增加6-TGN水平超过180pmol/8×108RBC对缓解率的影响微乎其微。不良事件发生率在6-TGN水平为355 pmol/8×108 RBC的患者中显著增加(8.0%，6-TGN水平为355 Pmol/8×108RBCvs2.7%，6-TGN水平为355 Pmol/8×108 RBC，P=0.035)。
Background and AimMeasuring 6‐thioguanine nucleotide (6‐TGN) level is useful in optimizing dose of azathioprine (AZA) and monitoring for toxicity. Lower dose of AZA was suggested for maintenance of clinical remission in Asian patients than Caucasian patients with Crohn's disease (CD). However, the optimal 6‐TGN threshold required in Asian patients is undetermined. Therefore, the aim of the current study is to explore the optimal 6‐TGN threshold required in Asian patients with CD for maintenance of clinical remission.MethodsA retrospective cohort study in a tertiary referral center recruited 252 CD patients. The primary endpoint was disease relapse. The levels of 6‐TGN and AZA dose were compared in remission group and relapse group. Remission rate was compared across the increased 6‐TGN level and dose range.ResultsPatients with 6‐TGN range of 0–180.94 pmol/8 × 108red blood cells (RBC) had lower remission rate compared with those with 180.94–255.50 pmol/8 × 108RBC (P= 0.020). Quartile analysis showed that increasing 6‐TGN level beyond 180 pmol/8 × 108RBC produced negligible gain in rate of remission. Frequency of adverse events significantly increased in patients with 6‐TGN level > 355 pmol/8 × 108RBC (8.0% with 6‐TGN > 355 pmol/8 × 108RBCvs2.7% with 6‐TGN < 355 pmol/8 × 108RBC,P= 0.035).ConclusionOur study suggested that optimal 6‐TGN threshold required to maintain clinical remission in Chinese patients was 180–355 pmol/8 × 108RBC.