Abstract
Purpose: 6-TG has been suggested as an alternative treatment option for patients with inflammatory bowel disease (IBD). However, hepatotoxicity, especially nodular regenerative hyperplasia (NRH) has been described leading to recommendation not to consider the drug for long term treatment of IBD. We would like to report our experience from a single tertiary referral center with the use of 6-TG for treatment of IBD. Methods: Retrospective case series study. We reviewed patient charts including hospital and outpatient electronic record/chart of all patients followed in our adult IBD clinic over past 5 years. We identified patients on 6-TG and reviewed their charts for duration of treatment with 6-TG and adverse reactions, specifically abnormal liver function tests (LFTS), NRH and lymphoma during their follow-up. Results: We reviewed the medical records of 289 patients followed in our adult IBD clinic over the past 5 years. Of these, 24 patients were treated with 6-TG, 7 male (29%) and 17 (71%) female patients, mean age of 48 years (range 17 to 86 years), 23 patients had crohn's disease and one had ulcerative colitis. The mean duration of treatment with 6-TG was 21 months (range from 2 months to 72 months). Only 2 patients, 1 male and 1 female, had significant elevation in their LFTs on 6-TG. Both underwent liver biopsy with only one (4%) reported to have NRH on liver biopsy. This patient discontinued 6-TG, with complete normalization of his LFTs. No lymphoma was detected in any patients receiving 6-TG. Conclusion: 6-TG is rarely associated with NRH. This drug has been used at our center for treatment of patients who cannot tolerate on other immunosuppressive agents. 6-TG is an alternative immunosupressive agent that can be safely considered in the treatment of IBD. Prospective studies will be needed to further evaluate for long term safety and efficacy of 6-TG in treatment of IBD.
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