How are thiopurines used and monitored by Swedish gastroenterologists when treating patients with inflammatory bowel disease?

Hindorf, Ulf; Andersson, Philip

doi:10.3109/00365521.2011.603162

Cited by 9 publications

(12 citation statements)

References 22 publications

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“…Despite the widespread use of thiopurines and the growing knowledge about their interindividual variations in metabolism, monitoring of thiopurine metabolites is not widely used: at least two recently published surveys reveal that determination of TPMT activity (genotype or phenotype), 6TGN or 6MMP levels is used by a relatively low proportion of IBD gastroenterologist, the availability or reimbursement issues being the most relevant obstacles 34 35…”

Section: Monitoring Thiopurine Metabolitesmentioning

confidence: 99%

Monitoring thiopurine metabolites in inflammatory bowel disease

González-Lama

Gisbert²

2016

Frontline Gastroenterol

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Thiopurines (azathioprine and mercaptopurine) are one of the immunosuppressive mainstays for the treatment of inflammatory bowel disease. In spite of its widespread use, thiopurine metabolism is still not fully understood, and a significant proportion of patients suffer toxicity or lack of efficacy. Different enzymatic pathways with individual variations constitute a pharmacogenetic model that seems to be suitable for monitoring and therapeutic intervention. This review is focused on current concepts and recent research that may help clinicians to rationally optimise thiopurine treatment in patients with inflammatory bowel disease.

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Section: Monitoring Thiopurine Metabolitesmentioning

confidence: 99%

Monitoring thiopurine metabolites in inflammatory bowel disease

González-Lama

Gisbert²

2016

Frontline Gastroenterol

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“…The results show that thiopurines are well established in the treatment of IBD and also new knowledge about thiopurine therapy largely has been adapted with a clear agreement regarding indications, dosing and monitoring, as reported by Hindorf and Andersson [12].…”

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confidence: 74%

Editorial

Andersson¹

2011

Scandinavian Journal of Gastroenterology

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“…Even though this study has important limitations such as the management of the patients including concomitant drugs, it is suggested that the practice of examining TPMT genotype and TPMT activity prior to starting therapy with thiopurines has improved our ability to manage these patients more effectively and safely than previously. The practice of monitoring thiopurine metabolism has been well established in several countries such as Sweden, UK, New Zealand [19,37,38], where the national guidelines for treatment of IBD state that TPMT genotype and/or phenotype determination should be considered in all patients prior to initiation of thiopurine treatment. Recently, Chouchana et al [18] proposed a therapeutic algorithm allowing a dosage individualization to optimize and secure the management of patients under thiopurines.…”

Section: Discussionmentioning

confidence: 99%

P228 Thiopurine methyltransferase genotype and thiopurine S-methyltransferase activity in Greek children with inflammatory bowel disease

Gazouli¹,

Pachoula²,

Panayotou³

et al. 2012

Journal of Crohn's and Colitis

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BackgroundAzathioprine (AZA) and 6-mercaptopurine (6MP) are used in the treatment of pediatric inflammatory bowel disease (IBD). Genetic variations in thiopurine S-methyltranfarase (TPMT) gene have been correlated with enzyme activity and with the occurrence of adverse events to AZA and 6MP. The aim of the present study was to examine the sensitivity and specificity of TPMT genotyping for TPMT enzymatic activity, reducing harm from thiopurine by pretesting, and the association of thiopurine toxicity with TPMT status in children with IBD.MethodsTPMT red blood cell (RBC) activity was measured by using a radiochemical method and genotype was determined for the TPMT alleles *2, *3A, *3B and *3C in 108 thiopurinetreated pediatric IBD patients with a mean age of 11.3 years (range 3-16).ResultsSignificant TPMT activity differences between wild-type and heterozygous and homozygous mutated subjects were observed. We divided TPMT activity into three categories according to frequency distribution: low (16.67%), intermediate (25.92%) and high (57.41%). The whole population included a total of 77.78% of homozygous wild-type subjects, 15.74% heterozygous variants, 1.85% homozygous variants and five (4.63%) compound heterozygous variant TPMT*3B/*3C. The overall concordance rate between TPMT genotypes and phenotypes was 88.2%. Seven carriers of at least one variant allele and low or intermediate TPMT activity developed adverse effects.ConclusionsOur findings suggest that carriers of at least one variant allele and both intermediate and absent TPMT activity have an increased risk of developing thiopurine-induced myelotoxicity compared with individuals with normal genotype and TPMT activity.

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How are thiopurines used and monitored by Swedish gastroenterologists when treating patients with inflammatory bowel disease?

Cited by 9 publications

References 22 publications

Monitoring thiopurine metabolites in inflammatory bowel disease

Monitoring thiopurine metabolites in inflammatory bowel disease

Editorial

P228 Thiopurine methyltransferase genotype and thiopurine S-methyltransferase activity in Greek children with inflammatory bowel disease

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