TY - JOUR
T1 - 6-Thioguanine treatment in inflammatory bowel disease
T2 - A critical appraisal by a European 6-TG working party
AU - De Boer, N. K.H.
AU - Reinisch, W.
AU - Teml, A.
AU - Van Bodegraven, A. A.
AU - Schwab, M.
AU - Lukas, M.
AU - Ochsenkühn, T.
AU - Petritsch, W.
AU - Knoflach, P.
AU - Almer, S.
AU - Van Der Merwe, S. W.
AU - Herrlinger, K. R.
AU - Seiderer, J.
AU - Vogelsang, H.
AU - Mulder, C. J.J.
PY - 2006/4/1
Y1 - 2006/4/1
N2 - 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.
AB - 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.
KW - 6-Thioguanine
KW - Crohn's disease and ulcerative colitis
KW - Inflammatory bowel disease
KW - Thiopurine
UR - http://www.scopus.com/inward/record.url?scp=33744490627&partnerID=8YFLogxK
U2 - https://doi.org/10.1159/000091662
DO - https://doi.org/10.1159/000091662
M3 - Article
C2 - 16493198
SN - 0012-2823
VL - 73
SP - 25
EP - 31
JO - Digestion
JF - Digestion
IS - 1
ER -