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Predictors of azathioprine toxicity in children with autoimmune hepatitis

AIM OF THE STUDY: Azathioprine (AZA) is an important steroid-sparing drug in the management of autoimmune hepatitis (AIH). Avoidance of its adverse events that could be severe and carry a risk of mortality in a few cases is important, preferably with cheap and easy assessments that could be feasible...

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Autores principales: Behairy, Behairy El-Sayed, El-Said, Hala Hany, Konswa, Hatem Abd-Alsattar, El-Deen, Ahmed El-Sayed Nour, Adawy, Nermin Mohamed, Sira, Ahmad Mohamed
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Termedia Publishing House 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8122100/
https://www.ncbi.nlm.nih.gov/pubmed/34027115
http://dx.doi.org/10.5114/ceh.2021.104634
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author Behairy, Behairy El-Sayed
El-Said, Hala Hany
Konswa, Hatem Abd-Alsattar
El-Deen, Ahmed El-Sayed Nour
Adawy, Nermin Mohamed
Sira, Ahmad Mohamed
author_facet Behairy, Behairy El-Sayed
El-Said, Hala Hany
Konswa, Hatem Abd-Alsattar
El-Deen, Ahmed El-Sayed Nour
Adawy, Nermin Mohamed
Sira, Ahmad Mohamed
author_sort Behairy, Behairy El-Sayed
collection PubMed
description AIM OF THE STUDY: Azathioprine (AZA) is an important steroid-sparing drug in the management of autoimmune hepatitis (AIH). Avoidance of its adverse events that could be severe and carry a risk of mortality in a few cases is important, preferably with cheap and easy assessments that could be feasible in developing countries with the unavailability of molecular assays. Assessment of thiopurine methyltransferase (TPMT), the key enzyme for the inactivation of AZA, as a predictor of AZA toxicity had been a matter of conflict. This work aimed to study the role of TPMT serum level assessment and other host-, disease-, and treatment-related factors in predicting AZA toxicity. MATERIAL AND METHODS: Sixty-six children with AIH, divided into two groups, were recruited. Group 1 included twelve children with AZA toxicity and group 2 included fifty-four children without AZA toxicities. Both groups were compared for demographic, clinical, laboratory, histopathological, and treatment-related factors, and serum TPMT level, measured by ELISA. RESULTS: TPMT serum level was comparable in both groups (p = 0.363). Duration of treatment until enzyme normalization and duration of AZA therapy were significantly associated with AZA toxicity (p = 0.007 and p = 0.01, respectively). At the first follow-up treatment with AZA, total leucocyte count (TLC) and neutrophil counts were significantly lower in group 1 (p = 0.005 and p = 0.002, respectively). Moreover, the percentage reduction of TLC and neutrophil counts were significantly higher in group 1 (p < 0.001, for both). CONCLUSIONS: Monitoring for AZA adverse events in those with the defined predictors of AZA-related adverse events is more important than TPMT assessment.
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spelling pubmed-81221002021-05-21 Predictors of azathioprine toxicity in children with autoimmune hepatitis Behairy, Behairy El-Sayed El-Said, Hala Hany Konswa, Hatem Abd-Alsattar El-Deen, Ahmed El-Sayed Nour Adawy, Nermin Mohamed Sira, Ahmad Mohamed Clin Exp Hepatol Original Paper AIM OF THE STUDY: Azathioprine (AZA) is an important steroid-sparing drug in the management of autoimmune hepatitis (AIH). Avoidance of its adverse events that could be severe and carry a risk of mortality in a few cases is important, preferably with cheap and easy assessments that could be feasible in developing countries with the unavailability of molecular assays. Assessment of thiopurine methyltransferase (TPMT), the key enzyme for the inactivation of AZA, as a predictor of AZA toxicity had been a matter of conflict. This work aimed to study the role of TPMT serum level assessment and other host-, disease-, and treatment-related factors in predicting AZA toxicity. MATERIAL AND METHODS: Sixty-six children with AIH, divided into two groups, were recruited. Group 1 included twelve children with AZA toxicity and group 2 included fifty-four children without AZA toxicities. Both groups were compared for demographic, clinical, laboratory, histopathological, and treatment-related factors, and serum TPMT level, measured by ELISA. RESULTS: TPMT serum level was comparable in both groups (p = 0.363). Duration of treatment until enzyme normalization and duration of AZA therapy were significantly associated with AZA toxicity (p = 0.007 and p = 0.01, respectively). At the first follow-up treatment with AZA, total leucocyte count (TLC) and neutrophil counts were significantly lower in group 1 (p = 0.005 and p = 0.002, respectively). Moreover, the percentage reduction of TLC and neutrophil counts were significantly higher in group 1 (p < 0.001, for both). CONCLUSIONS: Monitoring for AZA adverse events in those with the defined predictors of AZA-related adverse events is more important than TPMT assessment. Termedia Publishing House 2021-03-25 2021-03 /pmc/articles/PMC8122100/ /pubmed/34027115 http://dx.doi.org/10.5114/ceh.2021.104634 Text en Copyright © 2021 Clinical and Experimental Hepatology https://creativecommons.org/licenses/by-nc-sa/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0). License (http://creativecommons.org/licenses/by-nc-sa/4.0/ (https://creativecommons.org/licenses/by-nc-sa/4.0/) )
spellingShingle Original Paper
Behairy, Behairy El-Sayed
El-Said, Hala Hany
Konswa, Hatem Abd-Alsattar
El-Deen, Ahmed El-Sayed Nour
Adawy, Nermin Mohamed
Sira, Ahmad Mohamed
Predictors of azathioprine toxicity in children with autoimmune hepatitis
title Predictors of azathioprine toxicity in children with autoimmune hepatitis
title_full Predictors of azathioprine toxicity in children with autoimmune hepatitis
title_fullStr Predictors of azathioprine toxicity in children with autoimmune hepatitis
title_full_unstemmed Predictors of azathioprine toxicity in children with autoimmune hepatitis
title_short Predictors of azathioprine toxicity in children with autoimmune hepatitis
title_sort predictors of azathioprine toxicity in children with autoimmune hepatitis
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8122100/
https://www.ncbi.nlm.nih.gov/pubmed/34027115
http://dx.doi.org/10.5114/ceh.2021.104634
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