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. 2023 Jun;9(2):115-121.
doi: 10.5114/ceh.2023.127442. Epub 2023 Jun 26.

The relationship between 6-thioguanine levels and remission outcomes in children with autoimmune hepatitis. Single center experience

Dominika Kaps-Kopiec  1 , Agnieszka Czajkowska  2 , Marta Górska  2 , Małgorzata Woźniak  1 , Dorota Jarzębicka  1 , Joanna Cielecka-Kuszyk  3 , Piotr Czubkowski  1 , Joanna Pawłowska  1
Affiliations

The relationship between 6-thioguanine levels and remission outcomes in children with autoimmune hepatitis. Single center experience

Dominika Kaps-Kopiec et al. Clin Exp Hepatol. 2023 Jun.

Abstract

Aim of the study: The treatment of autoimmune hepatitis (AIH) is based on steroids and azathioprine (AZA). AZA is a pro-drug which is converted among others into 6-thioguanine (6-TG) and 6-methylmercaptopurine (6-MMP). The aim of the study was to determine the relationship between the AZA active metabolite 6-TG and both the biochemical and histological remission outcomes.

Material and methods: The authors conducted a retrospective analysis of a single chart review. The sample size consisted of 44 pediatric patients with AIH. Biochemical remission was defined as an alanine aminotransferase (ALT) level below 40 U/l and histological remission was defined as a situation when the control biopsy revealed inflammation grade G1 (or lower) in the Batts-Ludwig score. Statistical analysis was applied to assess the difference in remission outcomes in patients with different levels of 6-TG.

Results: In the benchmark variant of our statistical analysis, we found that the correlation between 6-TG and ALT in the sample was not statistically significant. Moreover, the difference between the mean levels of ALT in the populations in and without remission was not statistically significant (the p-value of the t-test was 0.16).

Conclusions: Our results tend to support the claim that there is no statistically significant relationship between 6-TG concentration and remission (both biochemical and histological) in pediatric patients with AIH.

Keywords: 6-thioguanine levels; autoimmune hepatitis; children; remission; treatment.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Sample characteristics: 6-thioguanine (6-TG) concentration and the level of alanine aminotransferase (ALT)
Fig. 2
Fig. 2
Variant A – empirical densities (A), ROC curve (B)
Fig. 3
Fig. 3
Variant B – empirical densities (A), ROC curve (B)
See this image and copyright information in PMC

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References

    1. Jimenez-Riviera C, Ling SC, Ahmed N, et al. . Incidence and characteristics of autoimmune hepatitis. Pediatrics 2015; 136: e1237-1248. - PubMed
    1. Deneau M, Jensen MK, Holmen J, et al. .. Primary sclerosing cholangitis, autoimmune hepatits, and overlap in Utah children: Epidemiology and natural history. Hepatology 2013; 58: 1392-1400. - PubMed
    1. Mieli-Vergani G, Vergani D, Baumann U, et al. . Diagnosis and management of pediatric autoimmune liver disease: ESPGHAN Hepatology Committee Position Statement. J Pediatr Gastroenterol Nutr 2018; 66: 345-360. - PubMed
    1. Sheiko MA, Sundaram SS, Capocelli KE, et al. . Outcomes in pediatric autoimmune hepatitis and significance of azathioprine metabolites. J Pediatr Gastroenetrol Nutr 2017; 65: 80-85. - PMC - PubMed
    1. Bolia R, Rajanayagam J, Hardikar W. Lower 6-MMP/6-TG ratio may be a therapeutic target in pediatric autoimmune hepatitis. J Pediatr Gastroenterol Nutr 2018; 67: 695-700. - PubMed