Source: Ophthalmology  |  Posted 9 years ago

The use of 6-thioguanine in patients with chronic active Crohn's disease is effective with acceptable short-term toxicity.

Dr KR Herrlinger from the Robert-Bosch-Hospital, Stuttgart, Germany, and colleagues, came to this conclusion following an open prospective study investigating the efficacy and safety of 6-thioguanine in 37 patients with chronic active Crohn's disease (Crohn's disease activity index of >150).

All patients were either steroid dependent, steroid refractory and /or intolerant or refractory to azathioprine. For the study, the patients were treated with 40mg/day of 6-thioguanine for 24 weeks. Dose escalation to 80 mg was allowed at week 12.

The researchers found that, by intention-to-treat analysis, 35% of patients achieved remission (13 out of 37). Twelve of the 13 patients achieved remission after 4 weeks of therapy. In total, 57% of patients (21 of 37) achieved a response. The mean Crohn's disease activity index decreased from 284 to 153.

The study agent 6-thioguanine was more effective in azathioprine- intolerant than in azathioprine-refractory patients. Sixteen patients were intolerant to azathioprine, 12 tolerated 6-thioguanine.

The adverse effects seen in the study included: phototoxicity, pancreatitis, headache, nausea, alopecia, arthralgia, minor infections and reversible elevation of transaminases. Six patients had to discontinue treatment. Leucopenia caused discontinuation for two patients.

The researchers concluded: "In this patient group with chronic active Crohn's disease, 6-thioguanine appeared to be effective with acceptable short-term toxicity, but long-term controlled trials are clearly needed to further define its role."