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Histological remission of autoimmune hepatitis after the addition of allopurinol and azathioprine dose reduction
Guedes, Ana Luiza Vilar; Andrade, Adriana Ribas; Nunes, Vinicius Santos; Lima, Fabiana Roberto; Mello, Evandro Sobroza de; Ono, Suzane Kioko; Terrabuio, Débora Raquel Benedita; Cançado, Eduardo Luiz Rachid.
  • Guedes, Ana Luiza Vilar; University of Sao Paulo. School of Medicine. Department of Gastroenterology. São Paulo. BR
  • Andrade, Adriana Ribas; University of Sao Paulo. School of Medicine. Department of Gastroenterology. São Paulo. BR
  • Nunes, Vinicius Santos; University of Sao Paulo. School of Medicine. Department of Gastroenterology. São Paulo. BR
  • Lima, Fabiana Roberto; University of Sao Paulo. School of Medicine. Department of Pathology. São Paulo. BR
  • Mello, Evandro Sobroza de; University of Sao Paulo. School of Medicine. Department of Pathology. São Paulo. BR
  • Ono, Suzane Kioko; University of Sao Paulo. School of Medicine. Department of Gastroenterology. São Paulo. BR
  • Terrabuio, Débora Raquel Benedita; University of Sao Paulo. School of Medicine. Department of Gastroenterology. São Paulo. BR
  • Cançado, Eduardo Luiz Rachid; University of Sao Paulo. Institute of Tropical Medicine of Sao Paulo. São Paulo. BR
Autops. Case Rep ; 7(2): 35-42, Apr.-June 2017. ilus
Article in English | LILACS | ID: biblio-905231
ABSTRACT
The standard therapy for some autoimmune diseases consists of a combination of corticosteroids and thiopurines. In non-responders to thiopurine drugs, the measurement of the metabolites of azathioprine, 6-thioguanine, and 6-methylmercaptopurine, can be a useful tool. The measurement has been used during the treatment of inflammatory bowel diseases and, less commonly, in autoimmune hepatitis. Many patients preferentially metabolize thiopurines to 6-methylmercaptopurine (6-MMP), which is potentially hepatotoxic, instead of 6-thioguanine, the active immunosuppressive metabolite. The addition of allopurinol shifts the metabolism of thiopurine towards 6-thioguanine, improving the immunosuppressive effect. We present the case of a 51-year-old female with autoimmune hepatitis who had a biochemical response after azathioprine and prednisone treatment without histological remission, and who preferentially shunted to 6-MMP. After the addition of allopurinol, the patient's 6-thioguanine levels increased, and she reached histological remission with a reduction of 67% of the original dose of azathioprine. The patient did not develop clinical manifestations as a consequence of her increased immunosuppressive state. We also review the relevant literature related to this issue. In conclusion, the addition of allopurinol to thiopurine seems to be an option for those patients who do not reach histological remission and who have a skewed thiopurine metabolite profile.
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Full text: Available Index: LILACS (Americas) Main subject: Azathioprine / Remission Induction / Allopurinol / Hepatitis, Autoimmune Limits: Female / Humans Language: English Journal: Autops. Case Rep Journal subject: Anatomia / Patologia Cl¡nica / Patologia Legal Year: 2017 Type: Article Affiliation country: Brazil Institution/Affiliation country: University of Sao Paulo/BR

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Full text: Available Index: LILACS (Americas) Main subject: Azathioprine / Remission Induction / Allopurinol / Hepatitis, Autoimmune Limits: Female / Humans Language: English Journal: Autops. Case Rep Journal subject: Anatomia / Patologia Cl¡nica / Patologia Legal Year: 2017 Type: Article Affiliation country: Brazil Institution/Affiliation country: University of Sao Paulo/BR