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

Objectives: Thioguanine (TG) has been shown as a safe alternative in adults with inflammatory bowel disease (IBD) who (lid 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 dtificile 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.

Automated summary

This study evaluated the safety of thioguanine (TG) as maintenance therapy for pediatric inflammatory bowel disease (IBD). The results showed that TG is a safe alternative for patients with AZA-induced pancreatitis.