Brief Communication | Open Access
Todd N Witte, Allen L Ginsberg, "Use of Allopurinol with Low-Dose 6-Mercaptopurine in Inflammatory Bowel Disease to Achieve Optimal Active Metabolite Levels: A Review of Four Cases and the Literature", Canadian Journal of Gastroenterology and Hepatology, vol. 22, Article ID 870981, 5 pages, 2008. https://doi.org/10.1155/2008/870981
Use of Allopurinol with Low-Dose 6-Mercaptopurine in Inflammatory Bowel Disease to Achieve Optimal Active Metabolite Levels: A Review of Four Cases and the Literature
BACKGROUND: At least one-third of patients with inflammatory bowel disease do not respond or are intolerant to therapy with 6-mercaptopurine (6-MP). A subgroup fails to attain optimal levels of 6-thioguanine nucleotide (6-TGN) and instead shunts to 6-methylmercaptopurine nucleotide (6-MMPN).PATIENTS AND METHODS: A retrospective chart review was conducted, and four patients are described who had been previously unable to achieve optimal 6-TGN metabolite levels until allopurinol was added to their treatment.RESULTS: All four patients achieved optimal 6-TGN levels and undetectable 6-MMPN with a mean 6-MP dose of 0.49 mg/kg. Three achieved steroid-free clinical remission. Two of those three patients had normalization of liver enzymes; one patient had baseline normal liver enzymes despite an initial 6-MMPN level of 27,369 pmol/8×108 red blood cells. Two patients experienced reversible leukopenia.CONCLUSIONS: Combination allopurinol and low-dose 6-MP is an effective means to achieve optimal metabolite levels and steroid-free clinical remission in previously refractory patients. Caution is advised.
Copyright © 2008 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.