Re: Mercaptopurine Alternative??

[Guest guest]

why are you taking mercaptopurine?

To: Sent: Wednesday, January 28, 2009 4:44:29 PMSubject: Mercaptopurine Alternative??

Hello All,Does anyone know of an alternative to mercaptopurine that works as well, almost as well or better?Thanks (uk)

[Guest guest]

Hi ;

Azathioprine is often used as a substitute for 6-mercaptopurine in

the treatment of IBD:

_______________________

Expert Rev Gastroenterol Hepatol. 2008 Feb;2(1):23-34.

Azathioprine in inflammatory bowel disease: improved molecular

insights and resulting clinical implications.

Atreya I, Neurath MF

Institute of Molecular Medicine and I. Medical Clinic, University of

Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany. imke.atreya@1-

med.klinik.uni-mainz.de

Azathioprine and 6-mercaptopurine represent important first-line

immunosuppressive drugs in the treatment of inflammatory bowel

disease. Owing to 45 years of clinical experience with thiopurines in

inflammatory bowel disease, there currently exist strong data from

numerous clinical trials and meta-analyses, which clearly document

the therapeutic efficacy of azathioprine and 6-mercaptopurine in the

treatment of inflammatory bowel disease. However, the exact molecular

mechanism of action of these drugs was insufficiently understood for

a long time. During the last few years, important new insights into

the intracellular effects of azathioprine have been gained and

thiopurines have been identified as strong inducers of T-cell

apoptosis. This article aims to summarize traditional and current

concepts of azathioprine-mediated effects and endeavors to discuss

the resulting clinical implications. PMID: 19072367.

_______________________

6-Thioguanine is also an alternative, but I think there are more

concerns with hepatoxicity with this drug:

_______________________

Inflamm Bowel Dis. 2008 Oct;14(10):1399-405.

Further experience with the use of 6-thioguanine in patients with

Crohn's disease.

Ansari A, Elliott T, Fong F, Arenas- M, Rottenberg G,

Portmann B, Lucas S, Marinaki A, on J

Department of Gastroenterology, Guy's & St. ' Hospitals NHS

Foundation Trust, London SE1 7EH, United Kingdom.

BACKGROUND: 6-Thioguanine (6-TG) is efficacious in patients with

Crohn's Disease (CD) failing conventional immunosuppression but there

are reports of hepatotoxicity. We report our experience of the safety

and efficacy of 6-TG in a series of patients with CD. METHODS: A

retrospective study of patients with CD who failed thiopurines +/-

methotrexate between 2001 and 2006 was performed. Indications for 6-

TG were; active disease, to allow infliximab withdrawal, steroid

sparing, or fistula closure. Patients underwent regular review and

those treated longer than 1 year were advised to have liver magnetic

resonance imaging (MRI) and liver biopsy. RESULTS: All 30 patients

treated with 6-TG during the period were included. The median dose

and duration of 6-TG was 40 mg daily and 21.5 months, respectively.

Initial clinical response was achieved in 18/30 (60%). Eleven of 29

(38%) (1 unrelated death) remained in remission at a median 44 months

follow-up. Seven of 30 (23%) discontinued 6-TG due to adverse

effects; 7/30 (23%) patients developed abnormal liver function tests

(LFTs) during treatment, mostly transient and mild. One patient

developed a portal hypertensive syndrome resolving on cessation of 6-

TG. Of 11 liver biopsies, none showed nodular regenerative

hyperplasia (NRH). The median red blood cell 6-thioguanine nucleotide

(6-TGN) level was 807 pmol/10(8). CONCLUSIONS: 6-TG has good clinical

efficacy for third-line immunosuppression in CD but hepatotoxicity

remains a concern. However, previous reports of NRH in 6-TG-treated

inflammatory bowel disease patients have not been substantiated by

this cohort. PMID: 18521912.

_______________________

Best regards,

Dave

(father of (23); PSC 07/03; UC 08/03)

>

> Hello All,

> Does anyone know of an alternative to mercaptopurine that works as

> well, almost as well or better?