J Pediatr Gastroenterol Nutr. 2022 Dec 1;75(6):e111-e115.doi: 10.1097/MPG.0000000000003621. Epub 2022 Sep 20.

Ahmed B Bayoumy ¹, Jasmijn Z Jagt ^2 3, Herbert M van Wering ⁴, Lissy de Ridder ⁵, Thalia Hummel ⁶, Victorien M Wolters ⁷, Janneke Stapelbroek ⁸, Marc A Benninga ⁹, Chris J J Mulder ¹⁰, Nanne K H de Boer ¹⁰, Tim G J de Meij ^2 9; Kids with Crohn’s, Colitis (KiCC) Working Group for Collaborative Paediatric IBD Research in the Netherlands

Author information

¹From the Faculty of Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.

²the Department of Pediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.

³the Amsterdam UMC, Vrije Universiteit Amsterdam, Paediatric Gastroenterology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands.

⁴the Department of Pediatric Gastroenterology, Amphia Hospital, Breda, the Netherlands.

⁵the Department of Pediatric Gastroenterology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands.

⁶the Department of Pediatric Gastroenterology, Medisch Spectrum Twente, Enschede, the Netherlands.

⁷the Department of Pediatric Gastroenterology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.

⁸the Department of Pediatric Gastroenterology, Catharina Hospital, Eindhoven, the Netherlands.

⁹the Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.

¹⁰the Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.

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.