Thioguanine is effective as maintenance therapy for inflammatory bowel disease: a prospective multicentre registry study

BACKGROUND AND AIMS

Thioguanine is a well-tolerated and effective therapy for inflammatory bowel disease (IBD) patients. Prospective, effectiveness data are needed to substantiate the role of thioguanine as a maintenance therapy for IBD.

METHODS

IBD patients, who previously failed azathioprine or mercaptopurine, and initiated thioguanine were prospectively followed for 12 months starting when corticosteroid-free clinical remission was achieved (HBI ≤ 4 or SCCAI ≤ 2). Primary endpoint was corticosteroid-free clinical remission throughout 12 months. Loss of clinical remission was defined as SCCAI > 2 or HBI > 4, need of surgery, escalation of therapy, initiation of corticosteroids or study discontinuation. Additional endpoints were adverse events, drug survival, physician global assessment (PGA) and quality of life (QoL).

RESULTS

Sustained corticosteroid-free clinical remission at month 3, 6 or 12 months was observed in 75 (69%), 66 (61%) and 49 (45%) of 108 patients, respectively. Thioguanine was continued in 86 patients (80%) for at least 12 months. Loss of response (55%) included escalation to biologicals in 15%, corticosteroids in 10% and surgery in 3%. According to PGA scores, 82% of patients were still in remission after 12 months and QoL scores remained stable. Adverse events leading to discontinuation were reported in 11%, infections in 10%, myelo- and hepatotoxicity each in 6% and portal hypertension in 1% of patients.

CONCLUSION

Sustained corticosteroid-free clinical remission over 12 months was achieved in 45% of IBD patients on monotherapy with thioguanine. A drug continuation rate of 80%, together with favourable PGA and QoL scores, underlines the tolerability and effectiveness of thioguanine for IBD.

Validation of the Croatian and Lebanese Revised Illness Perception Questionnaires for Healthy People (IPQ-RH)

The absence of Croatian- and Arabic-language measures to assess illness representations has contributed to lack of research among Croatian and Lebanese populations. Utilising the robust confirmatory factor analysis (CFA) approach, this study aimed to validate Croatian and Arabic versions of the Revised Illness Perception Questionnaire for Healthy People (IPQ-RH) in the breast and cervical cancer contexts, and compared these illness perceptions among Croatian and Lebanese women living in Australia. Forward and back-translated versions of the IPQ-RH were administered in Croatian to Croatian-born (n = 238), and Arabic to Lebanese-born (n = 240) women. The IPQ-RH illness perceptions were assessed for each cancer type, and the Negative Affect (NA) subscale of the Positive and Negative Affect Schedule (PANAS) assessed discriminant validity. The CFA method demonstrated acceptable models across the Croatian and Lebanese IPQ-RH measures. The internal reliabilities for the IPQ-RH subscales were adequate and the subscales had low correlations with the NA subscale of the PANAS, indicating that the IPQ-RH measures are largely distinguishable from negative affective dispositions. These findings demonstrate that the Croatian and Lebanese IPQ-RH breast and cervical cancer measures have a factor structure similar to the originally developed IPQ-RH scale and provide further support for the theoretically developed illness representations.

[Hodgkin's lymphoma of the lungs]

A case of the patient with Hodgkin's lung lymphoma, who ten years ago was treated because of having Hodgkin's lymphoma of the mediastinum and neck, is reported in this paper. This time, the patient has been admitted to the hospital due to the pulmonary infiltration in the left upper lobe. As the etiology of the pulmonary infiltration could not be established by a routine diagnostic procedure (sputum cytology, catheter bronchial aspirate smears, bronchial brushing, excision of the bronchial mucosa, transtracheal and transbronchial aspiration), the transthoracic fine needle aspiration was performed to confirm the diagnosis. Cytologically, beside erythrocytes, the cells of the bronchial epithelium, eosinophilic granulocytes and lymphocytes, the cells of the Reed-Sternberg cell type were found in the transthoracic aspirate smears too.