THE TREATMENT OF ACTIVE CHRONIC HEPATITIS WITH 6‐MERCAPTOPURINE AND AZATHIOPRINE

Abstract

SUMMARY 6‐Mercaptopurine (6‐MP) or azathioprine was given to 17 patients with active chronic hepatitis. In eight cases toxic reactions were observed, and these included anorexia, jaundice, hepatic coma, thrombocytopenia and leukopenia. Toxicity appeared to be related to both the dose of the drug and the severity of the underlying liver disease, assessed by the extent of parenchymal necrosis. Although 100 to 125 mg. of 6‐MP is well below the accepted toxic dose in leukæmia, it appears to be excessive for many patients with active chronic hepatitis. 6‐MP or azathioprine at a lower dose range was used in 14 cases for periods of up to four and a half years with complete freedom from toxicity. Our data suggest that at the present time 6‐MP or azathioprine is the drug of choice for patients in whom complications to steroids develop, or when “control” of the disease cannot be achieved with steroid therapy. Although the clinical and biochemical indices of activity can be more adequately “controlled”, and the time spent in hospital markedly reduced when compared with steroid treated cases, drug therapy does not appear to be effective in altering long‐term survival or arresting the progressive fibrosis in the liver. Used judiciously in the dose levels indicated, azathioprine and 6‐MP appear to be the most effective drugs to suppress the activity of active chronic hepatitis, and are free of complications when used for long periods of time.