Safety of Thioguanine in Pediatric Inflammatory Bowel Disease: A Multi-Center Case Series

Ahmed B. Bayoumy; Jasmijn Z. Jagt; Herbert M. Van Wering; Lissy De Ridder; Thalia Hummel; Victorien M. Wolters; Janneke Stapelbroek; Marc A. Benninga; Chris J.J. Mulder; Nanne K.H. De Boer; Tim G.J. De Meij

doi:10.1097/MPG.0000000000003621

Safety of Thioguanine in Pediatric Inflammatory Bowel Disease: A Multi-Center Case Series

Ahmed B. Bayoumy
, Jasmijn Z. Jagt
, Herbert M. Van Wering
, Lissy De Ridder
, Thalia Hummel
, Victorien M. Wolters
, Janneke Stapelbroek
, Marc A. Benninga
, Chris J.J. Mulder
, Nanne K.H. De Boer
, Tim G.J. De Meij^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Objectives: Thioguanine (TG) has been shown as a safe alternative in adults with inflammatory bowel disease (IBD) who did not tolerate conventional thiopurines [azathioprine (AZA)/mercaptopurine]. However, data in pediatric IBD are scarce. Therefore, we aimed to assess the safety of TG as maintenance therapy. Methods: A retrospective, multicenter cohort study of children with IBD on TG was performed in the Netherlands. TG-related adverse events (AE) were assessed and listed according to the common terminology criteria for AE. Results: Thirty-six children with IBD (median age 14.5 years) on TG (median dose 15 mg/day) were included in 6 centers. Five AE occurred during follow-up [pancreatitis (grade 3), hepatotoxicity (grade 3) (n = 2), Clostridium difficile infection (grade 2), and abdominal pain (grade 2)]. All patients (n = 8) with a previously AZA-induced pancreatitis did not redevelop pancreatitis on TG. Conclusions: In pediatric IBD, TG seems a safe alternative in case of AZA-induced pancreatitis. Further research assessing long-Term TG-related safety and efficacy is needed.

Original language	English
Pages (from-to)	E111-E115
Journal	Journal of Pediatric Gastroenterology and Nutrition
Volume	75
Issue number	6
DOIs	https://doi.org/10.1097/MPG.0000000000003621
Publication status	Published - 1 Dec 2022

Keywords

inflammatory bowel disease
pediatrics
thioguanine
thiopurines

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Safety_of_Thioguanine_in_Pediatric_Inflammatory.10Final published version, 257 KBLicence: CC BY

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Bayoumy, A. B., Jagt, J. Z., Van Wering, H. M., De Ridder, L., Hummel, T., Wolters, V. M., Stapelbroek, J., Benninga, M. A., Mulder, C. J. J., De Boer, N. K. H., & De Meij, T. G. J. (2022). Safety of Thioguanine in Pediatric Inflammatory Bowel Disease: A Multi-Center Case Series. Journal of Pediatric Gastroenterology and Nutrition, 75(6), E111-E115. https://doi.org/10.1097/MPG.0000000000003621

@article{005301d531a54a38bad25cafc857a8a0,

title = "Safety of Thioguanine in Pediatric Inflammatory Bowel Disease: A Multi-Center Case Series",

abstract = "Objectives: Thioguanine (TG) has been shown as a safe alternative in adults with inflammatory bowel disease (IBD) who did not tolerate conventional thiopurines [azathioprine (AZA)/mercaptopurine]. However, data in pediatric IBD are scarce. Therefore, we aimed to assess the safety of TG as maintenance therapy. Methods: A retrospective, multicenter cohort study of children with IBD on TG was performed in the Netherlands. TG-related adverse events (AE) were assessed and listed according to the common terminology criteria for AE. Results: Thirty-six children with IBD (median age 14.5 years) on TG (median dose 15 mg/day) were included in 6 centers. Five AE occurred during follow-up [pancreatitis (grade 3), hepatotoxicity (grade 3) (n = 2), Clostridium difficile infection (grade 2), and abdominal pain (grade 2)]. All patients (n = 8) with a previously AZA-induced pancreatitis did not redevelop pancreatitis on TG. Conclusions: In pediatric IBD, TG seems a safe alternative in case of AZA-induced pancreatitis. Further research assessing long-Term TG-related safety and efficacy is needed.",

keywords = "inflammatory bowel disease, pediatrics, thioguanine, thiopurines",

author = "Bayoumy, \{Ahmed B.\} and Jagt, \{Jasmijn Z.\} and \{Van Wering\}, \{Herbert M.\} and \{De Ridder\}, Lissy and Thalia Hummel and Wolters, \{Victorien M.\} and Janneke Stapelbroek and Benninga, \{Marc A.\} and Mulder, \{Chris J.J.\} and \{De Boer\}, \{Nanne K.H.\} and \{De Meij\}, \{Tim G.J.\}",

note = "Funding Information: N.K.H.d.B has served as a speaker for AbbVie and MSD has served as consultant and/or principal investigator for TEVA Pharma BV and Takeda. He has received a (unrestricted) research grant from Dr Falk, TEVA Pharma BV, MLDS and Takeda. L.d.R. has been involved in industry sponsored studies, investigator initiated study and/or consultancy with AbbVie, Lilly, Takeda, Janssen and Pfizer and received research grants from ZonMw, ECCO, and Pfizer. All authors declare that they have seen and approved the final version of the manuscript. The remaining authors report no conflicts of interest. Publisher Copyright: {\textcopyright} 2022 Lippincott Williams and Wilkins. All rights reserved.",

year = "2022",

month = dec,

day = "1",

doi = "10.1097/MPG.0000000000003621",

language = "English",

volume = "75",

pages = "E111--E115",

journal = "Journal of Pediatric Gastroenterology and Nutrition",

issn = "0277-2116",

publisher = "John Wiley \& Sons Inc.",

number = "6",

}

Bayoumy, AB, Jagt, JZ, Van Wering, HM, De Ridder, L, Hummel, T, Wolters, VM, Stapelbroek, J, Benninga, MA, Mulder, CJJ, De Boer, NKH & De Meij, TGJ 2022, 'Safety of Thioguanine in Pediatric Inflammatory Bowel Disease: A Multi-Center Case Series', Journal of Pediatric Gastroenterology and Nutrition, vol. 75, no. 6, pp. E111-E115. https://doi.org/10.1097/MPG.0000000000003621

TY - JOUR

T1 - Safety of Thioguanine in Pediatric Inflammatory Bowel Disease

T2 - A Multi-Center Case Series

AU - Bayoumy, Ahmed B.

AU - Jagt, Jasmijn Z.

AU - Van Wering, Herbert M.

AU - De Ridder, Lissy

AU - Hummel, Thalia

AU - Wolters, Victorien M.

AU - Stapelbroek, Janneke

AU - Benninga, Marc A.

AU - Mulder, Chris J.J.

AU - De Boer, Nanne K.H.

AU - De Meij, Tim G.J.

N1 - Funding Information: N.K.H.d.B has served as a speaker for AbbVie and MSD has served as consultant and/or principal investigator for TEVA Pharma BV and Takeda. He has received a (unrestricted) research grant from Dr Falk, TEVA Pharma BV, MLDS and Takeda. L.d.R. has been involved in industry sponsored studies, investigator initiated study and/or consultancy with AbbVie, Lilly, Takeda, Janssen and Pfizer and received research grants from ZonMw, ECCO, and Pfizer. All authors declare that they have seen and approved the final version of the manuscript. The remaining authors report no conflicts of interest. Publisher Copyright: © 2022 Lippincott Williams and Wilkins. All rights reserved.

PY - 2022/12/1

Y1 - 2022/12/1

N2 - Objectives: Thioguanine (TG) has been shown as a safe alternative in adults with inflammatory bowel disease (IBD) who did not tolerate conventional thiopurines [azathioprine (AZA)/mercaptopurine]. However, data in pediatric IBD are scarce. Therefore, we aimed to assess the safety of TG as maintenance therapy. Methods: A retrospective, multicenter cohort study of children with IBD on TG was performed in the Netherlands. TG-related adverse events (AE) were assessed and listed according to the common terminology criteria for AE. Results: Thirty-six children with IBD (median age 14.5 years) on TG (median dose 15 mg/day) were included in 6 centers. Five AE occurred during follow-up [pancreatitis (grade 3), hepatotoxicity (grade 3) (n = 2), Clostridium difficile infection (grade 2), and abdominal pain (grade 2)]. All patients (n = 8) with a previously AZA-induced pancreatitis did not redevelop pancreatitis on TG. Conclusions: In pediatric IBD, TG seems a safe alternative in case of AZA-induced pancreatitis. Further research assessing long-Term TG-related safety and efficacy is needed.

AB - Objectives: Thioguanine (TG) has been shown as a safe alternative in adults with inflammatory bowel disease (IBD) who did not tolerate conventional thiopurines [azathioprine (AZA)/mercaptopurine]. However, data in pediatric IBD are scarce. Therefore, we aimed to assess the safety of TG as maintenance therapy. Methods: A retrospective, multicenter cohort study of children with IBD on TG was performed in the Netherlands. TG-related adverse events (AE) were assessed and listed according to the common terminology criteria for AE. Results: Thirty-six children with IBD (median age 14.5 years) on TG (median dose 15 mg/day) were included in 6 centers. Five AE occurred during follow-up [pancreatitis (grade 3), hepatotoxicity (grade 3) (n = 2), Clostridium difficile infection (grade 2), and abdominal pain (grade 2)]. All patients (n = 8) with a previously AZA-induced pancreatitis did not redevelop pancreatitis on TG. Conclusions: In pediatric IBD, TG seems a safe alternative in case of AZA-induced pancreatitis. Further research assessing long-Term TG-related safety and efficacy is needed.

KW - inflammatory bowel disease

KW - pediatrics

KW - thioguanine

KW - thiopurines

UR - https://www.scopus.com/pages/publications/85142403262

U2 - 10.1097/MPG.0000000000003621

DO - 10.1097/MPG.0000000000003621

M3 - Article

C2 - 36136124

AN - SCOPUS:85142403262

SN - 0277-2116

VL - 75

SP - E111-E115

JO - Journal of Pediatric Gastroenterology and Nutrition

JF - Journal of Pediatric Gastroenterology and Nutrition

IS - 6

ER -

Safety of Thioguanine in Pediatric Inflammatory Bowel Disease: A Multi-Center Case Series

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