ECCO consensus: Evidence-based use of 6-thioguanine therapy in Crohn's disease?

摘要

With great interest, we have read the updated ECCO consensus on the treatment of Crohn's disease.Being highly interested in research on the clinical use of thiopurines, we feel that several additional comments may give opportunity to a more balanced, evidence-based conclusion on the discarded use of 6-thioguanine as an alternative thiopurine.Firstly, the authors state that 6-thioguanine is the active metabolite of azathioprine and mercaptopurine. The drug 6-thioguanine has no pharmacological activity itself but needs to be metabolised to exert its immunomodulatory effects. The pharmacologically active anti-inflammatory metabolites of all clinically used thiopurines (azathioprine, mercaptopurine and 6-thioguanine) are believed to be the 6-thioguanine nucleotides. These endmetabolites cannot be administered as a drug itself.