Thioguanine well-tolerated as second-line therapy for IBD
Thioguanine was well-tolerated in patients with inflammatory bowel disease who had previously failed treatment with conventional immunomodulators, according to recent findings published in United European Gastroenterology Journal. Further, nodular regenerative hyperplasia of the liver did not occur.
“The efficacy and side-effects were comparable to conventional immunomodulators and the safety data for [thioguanine (TG)] is reassuring,” Mark G. Ward, MD, in the department of gastroenterology at Guy’s and St. Thomas’ Hospital in London, NHS Foundation Trust, and colleagues wrote. “We acknowledge that the latter, rather than the clinical effectiveness of TG, is the key message that clinicians may find most useful when translating our findings to everyday clinical practice.”
Although TG is efficacious in treating IBD, it can cause nodular regenerative hyperplasia of the liver, which has limited its use. Ward and colleagues assessed the long-term clinical outcomes of TG in patients who had previously failed treatment with conventional immunomodulators.
In their retrospective single-center study, 54 patients with IBD were treated with TG as monotherapy (n = 36) or concomitantly with anti-tumor necrosis factor (n = 18) for a median of 16 months between 2001 and 2013. The researchers defined response as clinical remission without corticosteroids or, if receiving anti-TNF therapy, absence of dose escalation. They measured TG failure, withdrawal and adverse events.
Researchers found that 59% of patients responded to TG at 6 months and 43% responded at 12 months. Pancreatitis did not occur among the 19 patients with prior thiopurine-induced pancreatitis. While 30% of patients stopped TG due to intolerance or toxicity — with four serious cases — the researchers did not observe nodular regenerative hyperplasia.
Ward and colleagues concluded that TG was efficacious and well-tolerated.
“Head to head studies of TG versus conventional thiopurines would help establish the safety and efficacy of TG in IBD, but are unlikely to be undertaken,” they wrote. “Nonetheless, TG remains an acceptable alternative in patients with IBD who have not tolerated or have failed conventional immunomodulators.” – by Will Offit
Disclosure: The researchers report no relevant financial disclosures.