Promising treatment of autoimmune hepatitis with 6-thioguanine after adverse events on azathioprine

Nanne K.H. De Boer*, Carin M.J. Van Nieuwkerk, M. Nieves Aparicio Pages, Sybrand Y. De Boer, Luc J.J. Derijks, Chris J.J. Mulder

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


The use of corticosteroids in autoimmune hepatitis is an established therapy. To avoid the possible serious side effects of corticosteroids, immunosuppression with azathioprine is often warranted. Azathioprine, a purine analogue, is frequently used to taper or replace corticosteroids. However, approximately 10% of the patients are intolerant to azathioprine. Alternative therapies using mycophenolate, tacrolimus, budesonide, cyclosporine and 6-mercaptopurine have been studied, with variable results. The use of 6-thioguanine, an agent more directly leading to the down-stream active metabolites of azathioprine (6-thioguanine nucleotides) in inflammatory bowel disease patients intolerant to azathioprine or 6-mercaptopurine showed conflicting results. We report three patients with autoimmune hepatitis who could not tolerate azathioprine but tolerated 6-thioguanine 0.3 milligram per kilogram daily well. All three patients improved clinically. Therapeutic drug monitoring was performed. The prospective evaluation of 6-thioguanine as a possible immunosuppressive drug in autoimmune hepatitis patients is warranted.

Original languageEnglish
Pages (from-to)457-461
Number of pages5
JournalEuropean Journal of Gastroenterology and Hepatology
Issue number4
Publication statusPublished - 1 Apr 2005

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