Tioguanine as an alternative immunomodulator in inflammatory bowel diseases

Ali, Mohammad Shir; Laube, Robyn; Selvaratnam, Sriharan; Leong, Rupert W.

doi:10.1111/imj.15057

Cited by 3 publications

(2 citation statements)

References 5 publications

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“…[13] EEN is also effective in inducing remission, promoting fistula closure and reducing abscess size in patients with fistulising CD. [14,15] Therefore, early introduction of EEN is important for optimising nutrition and inducing remission. We successfully used EEN in 72% of our participants.…”

Section: Discussionmentioning

confidence: 99%

Multi-modal conservative management of intra-abdominal collections in fistulising Crohn’s disease

Shir Ali,

Leong,

Kariyawasam

et al. 2024

GIT

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Background and Objectives: The management of intra-abdominal collections in fistulising Crohn’s disease (CD) has traditionally involved surgery. However, conservative management is a potential alternative. In this study, we report our experience with multi-modal conservative management of intra-abdominal collections secondary to perforating CD. Methods: Medical records of CD patients with a history of intra-abdominal collections or fistulas over the past five years were reviewed retrospectively. Patients were included if they were initially managed conservatively using any combination of antibiotics, exclusive enteral nutrition (EEN), percutaneous drainage of collections, endoscopic dilatation of associated strictures and medical therapy for IBD with steroids, immunomodulators and/or biologics. Results: Eleven participants were included. All participants had penetrating CD affecting the terminal ileum. Nine participants had intra-abdominal collection on cross-sectional imaging whilst the remaining two participants had fistulising disease and sepsis without a discrete collection. Eight participants completed a 6–8 weeks course of EEN. All participants were treated with antibiotics and a thiopurine. Steroids were used in eight participants and biological agents in six. Six participants underwent endoscopic dilatation of small bowel strictures. After a median follow up of 20 months [range: 3–210] nine participants had evidence of adequate clinical, biochemical, radiological and endoscopic improvement. Complete resolution of abscess was seen in 4/7 participants and a significant reduction in abscess size was seen in 2/7. Two participants had complete endoscopic and histological remission and complete resolution of abscess. Both participants with fistulising disease (without a collection) had evidence of healed fistula tract on progress imaging and endoscopy. Two participants underwent surgery after failure of initial conservative management. Conclusion: Intra-abdominal collections in fistulising CD can be managed successfully in appropriately selected patients using a multi-modal approach incorporating antibiotics, EEN, endoscopic dilatations of culprit strictures and optimised medical management using steroids (for induction of remission), immunomodulators and biologics.

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Section: Discussionmentioning

confidence: 99%

Multi-modal conservative management of intra-abdominal collections in fistulising Crohn’s disease

Shir Ali,

Leong,

Kariyawasam

et al. 2024

GIT

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“…6 AEs including nodular regenerative hyperplasia are extremely rare with the doses used for IBD. [6][7][8][9] Additionally, thioguanine produces more predictable 6-TGN metabolites and may have a quicker onset of action and greater clinical efficacy than conventional thiopurines. 9 An interesting addition to the study would have been a third arm using thioguanine, which would mechanistically achieve similar effects to thiopurine/allopurinol co-therapy and would have been simpler to implement.…”

Section: Letter: Thioguanine An Underutilised Option In Inflammatory ...mentioning

confidence: 99%