Utility of Monitoring Azathioprine Metabolites in the Management of Children with Autoimmune HepatitisJannone BSG1, Kafka RNK2 and Schwarz KB2*
- *Corresponding Author:
- Kathleen B. Schwarz
Department of Pediatrics, University School of Medicine
CMSC 2-116, 600 North Wolfe St, Baltimore, Md. 21287, USA
Tel: 410 955 8769
Fax: 410 955 1464
E-mail: [email protected]
Received date: January 11, 2016 Accepted date: January 23, 2016 Published date: January 30, 2016
Citation: Jannone BSG, Kafka RNK, Schwarz KB (2016) Utility of Monitoring Azathioprine Metabolites in the Management of Children with Autoimmune Hepatitis. J Hepatol Gastroint Dis 2:114. doi:10.4172/2475-3181.1000114
Copyright: © 2016 Jannone BSG, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Aim: Although monitoring of the active metabolite (6-thioguanine or 6-TG) and hepatotoxic metabolite (6 methylmercaptopurine or 6-MMP) of the drugs azathioprine (AZA) or 6-mercaptopurine is well-established in children with inflammatory bowel disease, there is little information about the utility of this practice in children with AIH.
Objectives: The purpose of this single center retrospective study was two-fold: 1) To determine if metabolite monitoring (MM) was associated with improved clinical outcome and 2) To determine levels of 6-TG associated with remission.
Methods: Chart review was performed of all patients ages 0-21 years at the Johns Hopkins Hospital with definite or probable AIH from 1991 to 2012 seen over two years of follow up.
Results: Twenty-one patients with AIH met the inclusion criteria of pre-transplant state and treatment with AZA or 6-MP. 10 patients did not have MM (Group 1); 11 patients had MM at least once (Group 2). Average AZA dose for Group 1 patients was 1.2 (0.6-1.8) mg/kg/day vs. 1.9 (1.3-2.9) for Group 2 patients (P=0.002). 4/10 (40%) Group 1 patients achieved remission vs. 7/11 (64%) Group 2 patients (P=0.39). The average 6-TG level for Group 2 remission patients was 162.7 pmol/8 × 108 red blood cells (RBC) (41.5-316; N=7). One patient developed liver failure presumably secondary to AZA-cholestasis (6-MMP level of 6792 pmol/8 × 108 RBC), since it resolved with discontinuation of AZA.
Conclusions: MM in children with AIH may prove useful for determining 6TG levels associated with remission, permit dose escalation as necessary, and assist in determination of AZA toxicity.