Celiac.com 09/12/2012 - A team of researchers recently evaluated tioguanine as a treatment for refractory celiac disease type I. The very small study indicates that tioguanine, a thiopurine derivative, offers easy, efficient treatment for refractory celiac disease, compared with current treatment regimens.

Photo: CC--indi.caThe research team included G. J. Tack; D. P. van Asseldonk; R. L. J. van Wanrooij; A. A. van Bodegraven; and C. J. Mulder.

Refractory celiac disease type I is a form of celiac disease in which patients show resistance to a gluten-free diet, and suffer persistent or recurring intestinal villous atrophy, along with symptoms of malabsorption.

Currently, the most common treatment for refractory celiac disease type I relies on corticosteroids, though azathioprine is also sometimes used.

However, this small recent study shows that tioguanine might be better tolerated and more effective, in part because of its simpler metabolism towards bio-activation.

For their study, the research team set out to assess how well patients with refractory celiac disease type I tolerate tioguanine, and how effective it is in relieving symptoms.

The team studied a group of twelve patients with refractory celiac disease type I, who were treated with tioguanine between June 2001 and November 2010, including a follow-up period of at least 1 year.

The team assessed and recorded adverse events, laboratory values, 6-thioguanine nucleotide concentrations and rates of both clinical and histological response at baseline and during follow-up.

They noted that the average tioguanine treatment lasted 14 months. Ten patients tolerated long-term tioguanine treatment, while two patients discontinued treatment due to adverse reactions.

The team found no nodular regenerative hyperplasia of the liver. Follow-up showed clinical and histological response in 83% and 78% of patients, respectively. Overall, patients decreased corticosteroid reliance by 50%.

Because of its higher histological and similar clinical response rates compared with current treatments, tioguanine seems to be a good drug for treating refractory celiac disease type I.

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