Canadian Journal of Gastroenterology and Hepatology

Canadian Journal of Gastroenterology and Hepatology / 2008 / Article

Brief Communication | Open Access

Volume 22 |Article ID 870981 | https://doi.org/10.1155/2008/870981

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

Received02 Jun 2007
Accepted25 Jun 2007

Abstract

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.


More related articles

 PDF Download Citation Citation
 Order printed copiesOrder
Views216
Downloads265
Citations

Related articles

We are committed to sharing findings related to COVID-19 as quickly as possible. We will be providing unlimited waivers of publication charges for accepted research articles as well as case reports and case series related to COVID-19. Review articles are excluded from this waiver policy. Sign up here as a reviewer to help fast-track new submissions.