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Histological remission of autoimmune hepatitis after the addition of allopurinol and azathioprine dose reduction
The standard therapy for some autoimmune diseases consists of a combination of corticosteroids and thiopurines. In non-responders to thiopurine drugs, the measurement of the metabolites of azathioprine, 6-thioguanine, and 6-methylmercaptopurine, can be a useful tool. The measurement has been used du...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
São Paulo, SP: Universidade de São Paulo, Hospital Universitário
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5507567/ https://www.ncbi.nlm.nih.gov/pubmed/28740837 http://dx.doi.org/10.4322/acr.2017.021 |
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author | Guedes, Ana Luiza Vilar Andrade, Adriana Ribas Nunes, Vinicius Santos Lima, Fabiana Roberto de Mello, Evandro Sobroza Ono, Suzane Kioko Terrabuio, Débora Raquel Benedita Cançado, Eduardo Luiz Rachid |
author_facet | Guedes, Ana Luiza Vilar Andrade, Adriana Ribas Nunes, Vinicius Santos Lima, Fabiana Roberto de Mello, Evandro Sobroza Ono, Suzane Kioko Terrabuio, Débora Raquel Benedita Cançado, Eduardo Luiz Rachid |
author_sort | Guedes, Ana Luiza Vilar |
collection | PubMed |
description | The standard therapy for some autoimmune diseases consists of a combination of corticosteroids and thiopurines. In non-responders to thiopurine drugs, the measurement of the metabolites of azathioprine, 6-thioguanine, and 6-methylmercaptopurine, can be a useful tool. The measurement has been used during the treatment of inflammatory bowel diseases and, less commonly, in autoimmune hepatitis. Many patients preferentially metabolize thiopurines to 6-methylmercaptopurine (6-MMP), which is potentially hepatotoxic, instead of 6-thioguanine, the active immunosuppressive metabolite. The addition of allopurinol shifts the metabolism of thiopurine towards 6-thioguanine, improving the immunosuppressive effect. We present the case of a 51-year-old female with autoimmune hepatitis who had a biochemical response after azathioprine and prednisone treatment without histological remission, and who preferentially shunted to 6-MMP. After the addition of allopurinol, the patient’s 6-thioguanine levels increased, and she reached histological remission with a reduction of 67% of the original dose of azathioprine. The patient did not develop clinical manifestations as a consequence of her increased immunosuppressive state. We also review the relevant literature related to this issue. In conclusion, the addition of allopurinol to thiopurine seems to be an option for those patients who do not reach histological remission and who have a skewed thiopurine metabolite profile. |
format | Online Article Text |
id | pubmed-5507567 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | São Paulo, SP: Universidade de São Paulo, Hospital Universitário |
record_format | MEDLINE/PubMed |
spelling | pubmed-55075672017-07-24 Histological remission of autoimmune hepatitis after the addition of allopurinol and azathioprine dose reduction Guedes, Ana Luiza Vilar Andrade, Adriana Ribas Nunes, Vinicius Santos Lima, Fabiana Roberto de Mello, Evandro Sobroza Ono, Suzane Kioko Terrabuio, Débora Raquel Benedita Cançado, Eduardo Luiz Rachid Autops Case Rep Article / Clinical Case Report The standard therapy for some autoimmune diseases consists of a combination of corticosteroids and thiopurines. In non-responders to thiopurine drugs, the measurement of the metabolites of azathioprine, 6-thioguanine, and 6-methylmercaptopurine, can be a useful tool. The measurement has been used during the treatment of inflammatory bowel diseases and, less commonly, in autoimmune hepatitis. Many patients preferentially metabolize thiopurines to 6-methylmercaptopurine (6-MMP), which is potentially hepatotoxic, instead of 6-thioguanine, the active immunosuppressive metabolite. The addition of allopurinol shifts the metabolism of thiopurine towards 6-thioguanine, improving the immunosuppressive effect. We present the case of a 51-year-old female with autoimmune hepatitis who had a biochemical response after azathioprine and prednisone treatment without histological remission, and who preferentially shunted to 6-MMP. After the addition of allopurinol, the patient’s 6-thioguanine levels increased, and she reached histological remission with a reduction of 67% of the original dose of azathioprine. The patient did not develop clinical manifestations as a consequence of her increased immunosuppressive state. We also review the relevant literature related to this issue. In conclusion, the addition of allopurinol to thiopurine seems to be an option for those patients who do not reach histological remission and who have a skewed thiopurine metabolite profile. São Paulo, SP: Universidade de São Paulo, Hospital Universitário 2017-06-30 /pmc/articles/PMC5507567/ /pubmed/28740837 http://dx.doi.org/10.4322/acr.2017.021 Text en Autopsy and Case Reports. ISSN 2236-1960. Copyright © 2017. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium provided the article is properly cited. |
spellingShingle | Article / Clinical Case Report Guedes, Ana Luiza Vilar Andrade, Adriana Ribas Nunes, Vinicius Santos Lima, Fabiana Roberto de Mello, Evandro Sobroza Ono, Suzane Kioko Terrabuio, Débora Raquel Benedita Cançado, Eduardo Luiz Rachid Histological remission of autoimmune hepatitis after the addition of allopurinol and azathioprine dose reduction |
title | Histological remission of autoimmune hepatitis after the addition of allopurinol and azathioprine dose reduction |
title_full | Histological remission of autoimmune hepatitis after the addition of allopurinol and azathioprine dose reduction |
title_fullStr | Histological remission of autoimmune hepatitis after the addition of allopurinol and azathioprine dose reduction |
title_full_unstemmed | Histological remission of autoimmune hepatitis after the addition of allopurinol and azathioprine dose reduction |
title_short | Histological remission of autoimmune hepatitis after the addition of allopurinol and azathioprine dose reduction |
title_sort | histological remission of autoimmune hepatitis after the addition of allopurinol and azathioprine dose reduction |
topic | Article / Clinical Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5507567/ https://www.ncbi.nlm.nih.gov/pubmed/28740837 http://dx.doi.org/10.4322/acr.2017.021 |
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