Thiopurine metabolism monitoring: implications in inflammatory bowel diseases

Abstract

Background Thiopurines (TP) are widely used in the management of inflammatory bowel diseases. Side effects and inefficacy are a major concern as they lead to withdrawal of the drug.

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

“…These tests were mainly used for evaluating non-responders and suspected non-adherence to therapy, which in fact are the clinical settings where metabolite measurements were deemed useful in the national guidelines [9]. Furthermore, the strongest clinical evidence for metabolite testing is for treatment optimization and for identification of nonresponders that may be in need of alternative medical treatment [23]. Fewer respondents used metabolite measurements for the evaluation of thiopurine-related toxicity.…”

Cytomegalovirus Load in Inflamed Intestinal Tissue Is Predictive of Resistance to Immunosuppressive Therapy in Ulcerative Colitis

“…); (vii) patients with proctitis; and (viii) patients presenting Clostridium diffi cile infection in stool culture. For the 15 patients receiving AZA at inclusion, the rate of 6-thioguanine nucleotide, a marker of treatment effi cacy ( 24 ), was above 250 pmol / 8 × 10 8 erythrocytes.…”

Pharmacology and Optimization of Thiopurines and Methotrexate in Inflammatory Bowel Disease

“…1), are likely to block the thiopurine pathway, resulting in 6-MeMP overproduction (reviewed in refs. [77][78][79]). Moreover, genome-wide association studies have identified other genetic markers that predict the risk of developing potentially life-threatening, thiopurine-induced pancreatitis in patients with IBD [80].…”