Azathioprine Metabolite Measurements Are not Useful for Following Treatment of Autoimmune Hepatitis in Alaska Native and other Non-Caucasian People

Ferucci, Elizabeth D.; Hurlburt, Kathy J.; Mayo, Marlyn J.; Livingston, Stephen; Deubner, Heike; Gove, James; Plotnik, Julia; McMahon, Brian J.

doi:10.1155/2011/137476

Cited by 25 publications

(31 citation statements)

References 26 publications

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“…In Native Alaskan Americans and other non-Caucasian patients with AIH, 6-TGN and 6-MMP levels correlated with the dose of azathioprine only when TPMT enzyme activity was normal [146]. The frequency of normal TPMT enzyme activity was similar in patients with azathioprineinduced leukopenia and in patients without leukopenia.…”

Section: Testing For Thiopurine Methyltransferase and Azathioprine Mementioning

confidence: 81%

Autoimmune hepatitis

Sahebjam

Vierling

2015

Front. Med.

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Autoimmune hepatitis is a chronic liver disease putatively caused by loss of tolerance to hepatocyte-specific autoantigens. It is characterized by female predilection, elevated aminotransferase levels, autoantibodies, increased γ-globulin or IgG levels and biopsy evidence of interface hepatitis. It is currently divided into types 1 and 2, based on expression of autoantibodies. Autoantigenic epitopes have been identified only for the less frequent type 2. Although autoimmune hepatitis occurs in childhood, this review focuses on disease in adults. In the absence of pathognomonic biomarkers, diagnosis requires consideration of clinical, biochemical, serological and histological features, which have been codified into validated diagnostic scoring systems. Since many features also occur in other chronic liver diseases, these scoring systems aid evaluation of the differential diagnosis. New practice guidelines have redefined criteria for remission to include complete biochemical and histological normalization on immunosuppressive therapy. Immunosuppression is most often successful using prednisone or prednisolone and azathioprine; however, the combination of budesonide and azathioprine for non-cirrhotic patients offers distinct advantages. Patients failing standard immunosuppression are candidates for alternative immunosuppressive regimens, yet none of the options has been studied in a randomized, controlled trial. Overlap syndromes with either primary sclerosing cholangitis or primary biliary cirrhosis occur in a minority. Liver transplantation represents a life-saving option for patients presenting with acute liver failure, severely decompensated cirrhosis or hepatocellular carcinoma. Transplant recipients are at risk for recurrent autoimmune hepatitis in the allograft, and de novo disease may occur in patients transplanted for other indications. Patients transplanted for AIH are also at risk for recurrent or de novo inflammatory bowel disease. Progress in our understanding of the immunopathogenesis should lead to identification of specific diagnostic and prognostic biomarkers and new therapeutic strategies.

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Section: Testing For Thiopurine Methyltransferase and Azathioprine Mementioning

confidence: 81%

Autoimmune hepatitis

Sahebjam

Vierling

2015

Front. Med.

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“…64 Determinations of TPMT activity by phenotyping or genotyping have not been closely associated with the occurrence of azathioprine-induced side effects. [70][71][72][73] Routine pretreatment screening for TPMT activity has not been supported by strong clinical evidence, 1,2 but this determination can be useful in identifying the 0.3% of patients with absent enzyme activity. 71,74 Treatment Outcomes…”

Section: Treatment-related Side Effectsmentioning

confidence: 99%

Diagnosis and Management of Autoimmune Hepatitis

Czaja

2015

Clinics in Liver Disease

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“…Aza is converted non-enzymatically to 6-mercaptopurine (6-MP), and enzymatic metabolism of Alaskans and other non-Caucasians with AIH and normal TPMT activity 116 . Leukopenia was not a surrogate for TPMT activity, since patients with leukopenia on aza predominantly had normal TPMT activity 116 .…”

Section: Thiopurine Methyltransferase and Azathioprine Metabolitesmentioning

confidence: 99%

“…Leukopenia was not a surrogate for TPMT activity, since patients with leukopenia on aza predominantly had normal TPMT activity 116 .…”

Section: Thiopurine Methyltransferase and Azathioprine Metabolitesmentioning

confidence: 99%

Autoimmune Hepatitis and Overlap Syndromes: Diagnosis and Management

Vierling

2015

Clinical Gastroenterology and Hepatology

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Azathioprine Metabolite Measurements Are not Useful for Following Treatment of Autoimmune Hepatitis in Alaska Native and other Non-Caucasian People

Abstract: The present study confirmed the limited utility of monitoring levels of azathioprine metabolites in AIH patients.

Cited by 25 publications

References 26 publications

Autoimmune hepatitis

Autoimmune hepatitis

Diagnosis and Management of Autoimmune Hepatitis

Autoimmune Hepatitis and Overlap Syndromes: Diagnosis and Management

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