HOMEPRODUCTSCOMPANYCONTACTFAQResearchDictionaryPharmaSign Up FREE or Login

6-thioguanine nucleotide-adapted azathioprine therapy does not lead to higher remission rates than standard therapy in chronic active crohn disease: results from a randomized, controlled, open trial.

AbstractBACKGROUND:
A prospective randomized trial in patients with Crohn disease studied whether 6-thioguanine nucleotide (6-TGN) concentration-adapted azathioprine (AZA) therapy is clinically superior to a standard dose of 2.5 mg/kg/day AZA.
METHODS:
After 2 weeks of standard therapy, patients (n = 71) were randomized into standard (n = 32) or adapted-dose (n = 25) groups; 14 patients dropped out before randomization. In the adapted group, the AZA dose was adjusted to maintain 6-TGN concentrations between 250 and 400 pmol/8 x 10(8) erythrocytes (Ery). Response criteria were the number of patients in remission after 16 weeks without steroids (primary) and remission after 24 weeks, frequency of side effects, and quality of life (secondary).
RESULTS:
After 16 weeks, 14 of 32 (43.8%) patients in the standard group vs 11 of 25 (44%) in the adapted group were in remission without steroids (intent-to-treat analysis). After 24 weeks, 43.8% vs 40% were in remission. No significant differences were found concerning quality of life, disease activity, 6-TGN concentrations, AZA dose, or dropouts due to side effects. Sixty-six patients had a wild-type thiopurine S-methyltransferase (TPMT) genotype, with TPMT activities of 8 to 20 nmol/(mL Ery x h). Five patients (dropouts after randomization) were heterozygous, with TPMT activities <8 nmol/(mL Ery x h). 6-Methyl mercaptopurine (6-MMP) concentrations >5700 pmol/8 x 10(8) Ery were not associated with hepatotoxicity.
CONCLUSION:
Standard and adapted dosing with the provided dosing scheme led to identical 6-TGN concentrations and remission rates. Adapted dosing had no apparent clinical benefit for patients with TPMT activity between 8 and 20 nmol/(mL Ery x h). Additionally, 6-MMP monitoring had no predictive value for hepatotoxicity.
AuthorsMax Reinshagen, Ekkehard Schütz, Victor W Armstrong, Christoph Behrens, Christian von Tirpitz, Andreas Stallmach, Hans Herfarth, Jürgen Stein, Peter Bias, Guido Adler, Maria Shipkova, Wolfgang Kruis, Michael Oellerich, Nicolas von Ahsen
JournalClinical chemistry (Clin Chem) Vol. 53 Issue 7 Pg. 1306-14 (Jul 2007) ISSN: 0009-9147 [Print] England
PMID17495015 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
Chemical References
  • Guanine Nucleotides
  • Thionucleotides
  • azathiopurine
  • 6-thioguanylic acid
  • 6-methylthiopurine
  • Mercaptopurine
  • Methyltransferases
  • thiopurine methyltransferase
Topics
  • Adolescent
  • Adult
  • Aged
  • Chemical and Drug Induced Liver Injury (etiology)
  • Crohn Disease (drug therapy)
  • Dose-Response Relationship, Drug
  • Erythrocyte Indices
  • Female
  • Genotype
  • Guanine Nucleotides (blood)
  • Humans
  • Leukopenia (chemically induced)
  • Male
  • Mercaptopurine (administration & dosage, adverse effects, analogs & derivatives, blood, therapeutic use)
  • Methyltransferases (blood, genetics)
  • Middle Aged
  • Remission Induction
  • Thionucleotides (blood)
  • Thrombocytopenia (chemically induced)

Join CureHunter, for free Research Interface BASIC access!

Take advantage of free CureHunter research engine access to explore the best drug and treatment options for any disease. Find out why thousands of doctors, pharma researchers and patient activists around the world use CureHunter every day.
Realize the full power of the drug-disease research graph!


Choose Username:
Email:
Password:
Verify Password:
Enter Code Shown: