Promising treatment of autoimmune hepatitis with 6-thioguanine after adverse events on azathioprine
Promising treatment of autoimmune hepatitis with 6-thioguanine after adverse events on azathioprine
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DOI：
10.1097/00042737-200504000-00012
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发表时间：
2005-04-01
影响因子：
2.1
通讯作者：
Mulder, CJJ
中科院分区：
文献类型：
--
作者：
de Boer, NKH;van Nieuwkerk, CMJ;Mulder, CJJ
在自身免疫性肝炎中使用皮质类固醇是一种既定的治疗方法。为了避免皮质类固醇可能的严重副作用，硫唑嘌呤的免疫抑制往往是必要的。硫唑嘌呤是一种嘌呤类似物，常用于逐渐减少或替代皮质类固醇。然而，大约10%的患者对硫唑嘌呤不耐受。已研究了使用霉酚酸酯、他克莫司、布地奈德、环孢霉素和6-巯基嘌呤的替代疗法，结果各不相同。在对硫唑嘌呤或6-巯基嘌呤不耐受的炎性肠病患者中使用6-硫鸟嘌呤（一种更直接导致硫唑嘌呤下游活性代谢物（6-硫鸟嘌呤核苷酸）的药物）显示出相互矛盾的结果。我们报告三位自身免疫性肝炎患者，他们不能耐受硫唑嘌呤，但耐受6-硫鸟嘌呤0.3毫克/公斤，每天很好。所有3例患者的临床症状均得到改善。进行治疗药物监测。6-硫鸟嘌呤作为一种可能的免疫抑制药物在自身免疫性肝炎患者的前瞻性评价是必要的。(c)2005年利平科特威廉姆斯T威尔金斯。
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. (c) 2005 Lippincott Williams T Wilkins.