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To assess whether thiopurine\u2010induced liver injury coincides with increased oxidative stress and whether co\u2010administration with N\u2010acetylcysteine is protective, we performed a randomized open label crossover pilot study in inflammatory bowel disease patients with thiopurine\u2010induced increased serum liver tests. The study comprised four stages of 4\u2009weeks. Patients received no additional therapy followed by N\u2010acetylcysteine 1200\u2009mg twice a day, or the other way around, alongside ongoing thiopurine treatment. The third and fourth stages comprised a washout period and thiopurine reintroduction period. Nine patients completed the study, and the addition of N\u2010acetylcysteine decreased myeloperoxidase concentrations (33.6\u201324.5\u00a0pmol\/L, <jats:italic>p<\/jats:italic>\u2009=\u20090.038). The other biomarkers remained unchanged, including thiopurine metabolites, xanthine oxidase activity, thiopurine S\u2010methyltransferase activity and serum liver enzyme activity tests. Reintroduction of thiopurines led to an increase of F2\u2010isoprostanes (101\u2013157\u2009ng\/mmol, <jats:italic>p<\/jats:italic>\u2009=\u20090.038), but not of serum liver enzyme activity tests. Results suggests that thiopurines may increase oxidative stress and although the addition of N\u2010acetylcysteine led to a decrease in plasma myeloperoxidase concentrations, it does not protect from thiopurine\u2010induced increase of serum liver tests.<\/jats:p>","DOI":"10.1111\/bcpt.13978","type":"journal-article","created":{"date-parts":[[2024,1,29]],"date-time":"2024-01-29T11:13:50Z","timestamp":1706526830000},"page":"507-518","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Exploring the role of oxidative stress and the effect of N\u2010acetylcysteine in thiopurine\u2010induced liver injury in inflammatory bowel disease: A randomized crossover pilot study"],"prefix":"10.1111","volume":"134","author":[{"given":"Dirk P.","family":"van Asseldonk","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology Noordwest Ziekenhuisgroep  Alkmaar The Netherlands"},{"name":"Department of 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