mercaptopurine delayed release (DR6MP) / Teva 
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  • ||||||||||  6 Mercaptopurine / Teva
    Journal:  6-mercaptopurine, an agonist of Nur77, reduces progression of pulmonary hypertension by enhancing BMP signalling. (Pubmed Central) -  Oct 22, 2020   
    Pharmacological activation of Nur77 by 6-mercaptopurine markedly restored MVEC function by normalising proliferation, inflammation and BMP signaling. Finally, 6-mercaptopurine prevented and reversed abnormal vascular remodelling and right ventricle hypertrophy in the sugen-hypoxia rat model of severe angioproliferative PAH.Our data demonstrate that Nur77 is a critical modulator in PAH by inhibiting vascular remodelling and increasing BMP signalling, and activation of Nur77 could be a promising option for the treatment of PAH.
  • ||||||||||  Blincyto (blinatumomab) / Astellas, Amgen, 6 Mercaptopurine / Teva
    [VIRTUAL] Multiple relapsed acute lymphoblastic leukemia with t(9;13) in a child () -  Oct 21, 2020 - Abstract #EHOC2020EHOC_279;    
    Orchiectomy was performed for testicular relapse, and REZ-BFM 2016 protocol and then blinatumomab was given...He received weekly intrathecal chemotherapy and FLAG-IDA (fludarabine, high dose cytarabine, G-CSF, and idarubicin) protocol that continued with weekly oral methotrexate and daily 6-mercaptopurine and received 18 Gy cranial radiotherapy...However, two months later, he readmitted with headache and combined CNS and bone marrow involvement was detected and ETO-FLAG (fludarabine, high dose cytarabine, G-CSF, and etoposide) regimen was given. Treatment of relapsed ALL still is a challenge and experimental trials may be considered for these patients.
  • ||||||||||  methotrexate / Generic mfg., 6 Mercaptopurine / Teva
    Journal:  ARID5B influences anti-metabolite drug sensitivity and prognosis of acute lymphoblastic leukemia. (Pubmed Central) -  Oct 3, 2020   
    Treatment of relapsed ALL still is a challenge and experimental trials may be considered for these patients. Our data indicates that ARID5B is an important molecular determinant of antimetabolite drug sensitivity in ALL, in part through p21-mediated effects on cell-cycle progression.
  • ||||||||||  6 Mercaptopurine / Teva
    Clinical, Journal:  Longitudinal Patterns of Social Problem-Solving Skills in an Ethnically Diverse Sample of Pediatric Patients with Cancer and their Caregivers. (Pubmed Central) -  Sep 26, 2020   
    Pediatric patients with acute lymphoblastic leukemia and lymphoblastic lymphoma are prescribed a daily oral chemotherapy medication named 6-mercaptopurine...However, there were no significant differences observed for medication adherence. Our findings underscore the importance of implementing culturally sensitive interventions in clinical care that could ultimately positively impact health behaviors, interactions with healthcare providers, and long-term health outcomes.
  • ||||||||||  6 Mercaptopurine / Teva
    Clinical, Journal:  When Multiple Objective Measures of Medication Adherence Indicate Incongruent Adherence Results: An Example with Pediatric Cancer. (Pubmed Central) -  Sep 25, 2020   
    Additionally, individual- and family-level factors such as gender, socioeconomic status, household environment, and dose intensity will be examined to identify possible sources of discrepancies between adherence measures. This information will provide practical advice for physicians, healthcare providers, and psychologists in identifying nonadherence and the caveats therein so patients achieve the best possible health outcomes.
  • ||||||||||  Remicade (infliximab) / Mitsubishi Tanabe, J&J
    [VIRTUAL] A Platelet Problem: Profound Thrombocytopenia in the Setting of Inflammatory Bowel Disease Treatment () -  Sep 15, 2020 - Abstract #ACG2020ACG_2345;    
    Introduction: As effective treatment for Crohn’s Disease (CD) expands, the toxic effects of immunomodulators, such as azathioprine and its metabolite, 6-mercaptopurine, face increased scrutiny...Case Description/ A 36 year-old male with ileal CD on infliximab presented with 3 days of a rash after initiation of azathioprine 3 months prior...Due to persistent bleeding and thrombocytopenia, he was started on transexamic acid (TXA) and received a dose of romiplostim...The profound decrease in immature platelets in the setting of a petechial rash also implicates drug-induced ITP. The cytotoxic effects of CD8+ T lymphocytes in ITP cause additional platelet production impairment in a small number of ITP cases.
  • ||||||||||  Flagyl (metronidazole) / SLA, Stelara (ustekinumab) / J&J, Humira (adalimumab) / Eisai, AbbVie
    [VIRTUAL] Inflammatory or Infectious? When Amebiasis Mimics IBD () -  Sep 15, 2020 - Abstract #ACG2020ACG_2298;    
    He had some degree of response to prednisone and trialed a myriad of medications including adalimumab, ustekinumab, and 6-mercaptopurine with no improvement over a year...A hepatic drain was placed, and he was treated with metronidazole followed by paromomycin...When misdiagnosed with IBD, patients may receive immunosuppressants that can precipitate fulminant or disseminated disease. We propose that patients with seemingly refractory disease, discrete ulcers on colonoscopy, or recent travel warrant evaluation for amebiasis.
  • ||||||||||  Remicade (infliximab) / Mitsubishi Tanabe, J&J
    [VIRTUAL] A Whipping Case of Crohn's Disease () -  Sep 15, 2020 - Abstract #ACG2020ACG_2294;    
    Common complications related to HT include IDA, diarrhea, anorexia, dehydration and dysentery. Overall, HT for CD is not advised as it is controversial, of limited therapeutic efficacy, not FDA approved and can lead to more complications than therapeutic benefits.
  • ||||||||||  Remicade (infliximab) / Mitsubishi Tanabe, J&J, Humira (adalimumab) / Eisai, AbbVie
    [VIRTUAL] Lyme Arthritis Mimicking Inflammatory Bowel Disease-Associated Arthritis in Patient With Crohn’s Disease () -  Sep 15, 2020 - Abstract #ACG2020ACG_2286;    
    Infliximab was switched to adalimumab due to refractory joint pain...He was started on oral doxycycline resulting in gradual improvement in joint pain...Treatment of IBD associated arthritis includes addition of either sulfasalazine, methotrexate, azathioprine or 6-mercaptopurine. In resistant cases, TNF-alpha inhibitor can be initiated or switched to a second TNF inhibitor before trying another biologic agent, while Lyme’s arthritis is treated with antibiotics.
  • ||||||||||  Humira (adalimumab) / Eisai, AbbVie
    Clinical, Review, Journal:  Adalimumab for maintenance of remission in Crohn's disease. (Pubmed Central) -  Sep 13, 2020   
    Future research should continue to explore factors that influence initial and subsequent biologic selection for people with moderate-to-severe CD. Studies comparing adalimumab to other active medications are needed, to help determine the optimal maintenance therapy for CD.
  • ||||||||||  methotrexate / Generic mfg., 6 Mercaptopurine / Teva
    Clinical, Journal:  A mathematical model of white blood cell dynamics during maintenance therapy of childhood acute lymphoblastic leukemia. (Pubmed Central) -  Aug 12, 2020   
    We propose a novel comprehensive mathematical model for 6-MP and MTX pharmacokinetics, pharmacodynamics and myelosuppression in acute lymphoblastic maintenance therapy. We personalize and cross-validate the mathematical model using clinical data and propose a real-time algorithm to predict chemotherapy responses with a clinical decision support system as a potential future application.
  • ||||||||||  mercaptopurine delayed release (DR6MP) / Teva, allopurinol / Generic mfg.
    Review, Journal:  Use of Allopurinol to Mitigate 6-Mercaptopurine Associated Gastrointestinal Toxicity in Acute Lymphoblastic Leukemia. (Pubmed Central) -  Aug 9, 2020   
    Use of allopurinol for 6-MP related toxicities should be reserved for patients in which an alternative cause of signs or symptoms has been excluded and for whom non-pharmacologic measures have failed. When allopurinol is used, simultaneous dose reduction of 6-MP is required to avoid severe myelosuppression and related side effects, though overall combination therapy appears to be well-tolerated and effective when instituted appropriately.
  • ||||||||||  methotrexate / Generic mfg., mercaptopurine delayed release (DR6MP) / Teva, ibrutinib / Generic mfg.
    Clinical, Journal:  Management of giant cell hepatitis associated with chronic lymphocytic leukemia - a case series and review of the literature. (Pubmed Central) -  Aug 4, 2020   
    GCH has been associated with multiple causes including drugs (6-mercaptopurine, methotrexate), toxins, viruses and autoimmune...Prompt treatment of GCH with immunosuppression is required to prevent long-term liver toxicity. If transaminitis does not improve with immunosuppression alone, the addition of CLL directed therapy should be considered in patients who carry this diagnosis to prevent long-term liver toxicity.
  • ||||||||||  6 Mercaptopurine / Teva
    [VIRTUAL] Genetics and Mechanisms of Acute Lymphoblastic Leukemia (Virtual Session Room 3) -  Aug 4, 2020 - Abstract #ESHG2020ESHG_133;    
    Gain of function mutations in the 5'-Nucleotidase, Cytosolic II (NT5C2) gene are selectively present in relapsed ALL and confer resistance to chemotherapy with 6-mercaptopurine (6-MP)...In addition, using an in vivo leukemia model we demonstrate a dual role for NT5C2 R367Q, the most frequent relapse-associated NT5C2 allele, as a loss of fitness mutation impairing cell growth in the absence of chemotherapy, and a gain of fitness mutation resulting in disease progression and relapse in the context of 6-MP therapy. These results have important implications for monitoring of leukemia relapse driving clones and for the development of targeted therapies for the treatment of relapsed disease.
  • ||||||||||  6 Mercaptopurine / Teva
    Journal:  CCI52 sensitizes tumors to 6-mercaptopurine and inhibits MYCN-amplified tumor growth. (Pubmed Central) -  Jul 21, 2020   
    In addition to its chemosensitizing effects, CCI52 and CCI52-14 inhibited the growth of MYCN-amplified high-risk neuroblastoma cell lines and delayed tumor progression in a MYCN-driven, transgenic mouse model of neuroblastoma. These multifunctional inhibitors may be useful for the further development of anticancer agents and as tools to better understand 6-MP metabolism.
  • ||||||||||  mercaptopurine delayed release (DR6MP) / Teva
    Clinical, Journal:  Applying the COM-B model to patient-reported barriers to medication adherence in pediatric acute lymphoblastic leukemia. (Pubmed Central) -  Jul 16, 2020   
    The risk of developing infections during anti-TNFα therapy remains high, although not dissimilar to that found for other immunosuppressants, while concomitant immunosuppression and malnutrition appear the most important causes of infection. Our results suggest that parents and patients with ALL face various prevalent barriers to medication adherence and provide insight into the development of behavioral interventions focused on promoting adherence, which is essential to prevent relapse and optimize health outcomes in ALL.
  • ||||||||||  Humira (adalimumab) / Eisai, AbbVie
    [VIRTUAL] Intestinal Tuberculosis Mimics Crohn'S Disease. Diagnostic and Therapeutic Challenge. A Case Series (ATS 2020 Virtual) -  Jul 6, 2020 - Abstract #ATSI2020ATS-I_3528;    
    CASE SERIES: Case 1: 58 year-old male originally from Philippines who presented with bloody diarrhea and cramping, after workup by gastroenterologist, was diagnosed with CD and treated with 6-mercaptopurine and steroids...Humira was started bi-weekly but abdominal pain and bloody diarrhea continued...Diagnosed with CD and started in prednisone...TB should be considered in adults from endemic areas who present with chronic diarrhea when Prometheus studies are negative. Patients from endemic areas would benefit from further testing to rule out TB by MTB/PCR or AFB smear/culture.
  • ||||||||||  Remicade (infliximab) / Mitsubishi Tanabe, J&J
    [VIRTUAL] Necrobiotic Mass in Crohn's Disease: A Case Report (ATS 2020 Virtual) -  Jul 6, 2020 - Abstract #ATSI2020ATS-I_2735;    
    While necrobiotic inflammation should be recognized as a potential cause of pulmonary nodules and masses in Crohn's disease, this should be a viewed as a diagnosis of exclusion and only established after thorough workup to exclude infectious, vasculitic, and neoplastic etiologies. This case demonstrates that regression of a necrobiotic pulmonary mass can be anticipated by treating the underlying Crohn's disease with intensified immunosuppressive treatment.
  • ||||||||||  6 Mercaptopurine / Teva, azathioprine orodispersible / Generic mfg.
    [VIRTUAL] Mercaptopurine-induced Sweet syndrome in Crohn’s disease () -  Jul 1, 2020 - Abstract #SID2020SID_466;    
    Therefore, we propose that azathioprine-induced Sweet syndrome favors the extremities and can still occur even after chronic use of azathioprine or 6-MP and in the absence of neutrophilia. Recognizing these atypical features in this entity and differentiating it from classical inflammatory bowel disease (IBD)-associated Sweet syndrome is important to prevent mortality from azathioprine toxicity or hypersensitivity.