{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T09:22:45Z","timestamp":1773393765482,"version":"3.50.1"},"reference-count":25,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2018,8,15]],"date-time":"2018-08-15T00:00:00Z","timestamp":1534291200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Azathioprine (<jats:styled-content style=\"fixed-case\">AZA<\/jats:styled-content>) and mercaptopurine (<jats:styled-content style=\"fixed-case\">MP<\/jats:styled-content>) are the cornerstone of steroid\u2010sparing strategies in autoimmune hepatitis (<jats:styled-content style=\"fixed-case\">AIH<\/jats:styled-content>). Up to 20% of patients do not tolerate or respond to these regimens.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To evaluate retrospectively the tolerability and efficacy of tioguanine (thioguanine) (TG) therapy in selected patients with AIH and AIH variant syndromes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Records of 52 patients who received <jats:styled-content style=\"fixed-case\">TG<\/jats:styled-content> therapy were retrieved from nine hospitals in the Netherlands. Indications for <jats:styled-content style=\"fixed-case\">TG<\/jats:styled-content> treatment were intolerable side effects on <jats:styled-content style=\"fixed-case\">AZA<\/jats:styled-content> or <jats:styled-content style=\"fixed-case\">MP<\/jats:styled-content> (n\u00a0=\u00a038), insufficient response (n\u00a0=\u00a011) or first\u2010line treatment (n\u00a0=\u00a03). Treatment efficacy was defined as normalisation of serum aminotransferases and serum immunoglobulin G.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>No serious adverse events occurred in patients treated with <jats:styled-content style=\"fixed-case\">TG<\/jats:styled-content> during a median follow\u2010up of 18\u00a0months (range 1\u2010194). Treatment was well tolerated in 41 patients (79%), whereas four had tolerable (8%) and seven (13%) intolerable side effects. Thirty\u2010eight patients were treated with <jats:styled-content style=\"fixed-case\">TG<\/jats:styled-content> after intolerable side effects on <jats:styled-content style=\"fixed-case\">AZA<\/jats:styled-content> or <jats:styled-content style=\"fixed-case\">MP<\/jats:styled-content>; 29 patients continued <jats:styled-content style=\"fixed-case\">TG<\/jats:styled-content> therapy of whom 24 (83%) achieved complete biochemical remission, four (14%) had incomplete and one (3%) had no response; nine discontinued treatment. Seven of 11 patients with insufficient response to <jats:styled-content style=\"fixed-case\">AZA<\/jats:styled-content> or <jats:styled-content style=\"fixed-case\">MP<\/jats:styled-content> were responsive to <jats:styled-content style=\"fixed-case\">TG<\/jats:styled-content>, three with complete and four with incomplete biochemical remission; four discontinued due to intolerance (n\u00a0=\u00a02) and non\u2010response (n\u00a0=\u00a02). <jats:styled-content style=\"fixed-case\">TG<\/jats:styled-content> was effective in all <jats:styled-content style=\"fixed-case\">AIH<\/jats:styled-content> patients as first\u2010line maintenance treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In our retrospective review of <jats:styled-content style=\"fixed-case\">TG<\/jats:styled-content> therapy in selected patients with <jats:styled-content style=\"fixed-case\">AIH<\/jats:styled-content> or <jats:styled-content style=\"fixed-case\">AIH<\/jats:styled-content> variants who previously failed on <jats:styled-content style=\"fixed-case\">AZA<\/jats:styled-content> or <jats:styled-content style=\"fixed-case\">MP<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> TG<\/jats:styled-content> appeared tolerable with biochemical efficacy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.14939","type":"journal-article","created":{"date-parts":[[2018,8,15]],"date-time":"2018-08-15T09:13:20Z","timestamp":1534324400000},"page":"761-767","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Biochemical efficacy of tioguanine in autoimmune hepatitis: a retrospective review of practice in the Netherlands"],"prefix":"10.1111","volume":"48","author":[{"given":"Floris F.","family":"van den Brand","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology Amsterdam Gastroenterology and Metabolism Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carin M. J.","family":"van Nieuwkerk","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Amsterdam Gastroenterology and Metabolism Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bart J.","family":"Verwer","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Spaarne Gasthuis Haarlem The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ynto S.","family":"de Boer","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Amsterdam Gastroenterology and Metabolism Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nanne K. H.","family":"de Boer","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Amsterdam Gastroenterology and Metabolism Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chris J. J.","family":"Mulder","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Amsterdam Gastroenterology and Metabolism Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabeth","family":"Bloemena","sequence":"additional","affiliation":[{"name":"Department of Pathology Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine M.","family":"Bakker","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Zuyderland Medical Center Heerlen The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan M.","family":"Vrolijk","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Rijnstate Hospital Arnhem The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joost P. H.","family":"Drenth","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Radboud University Medical Center Nijmegen The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adriaan C. I. T. 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