Usefulness of the measurement of azathioprine metabolites in the assessment of non-adherence

Stocco, Gabriele; Londero, Margherita; Campanozzi, Angelo; Martelossi, Stefano; Marino, Sara; Malusà, Noelia; Bartoli, Fiora; Decorti, Giuliana; Ventura, Alessandro

doi:10.1016/j.crohns.2010.04.003

Cited by 22 publications

(17 citation statements)

References 17 publications

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“…This is especially relevant in those non-responding patients: low levels of 6TGN and 6MMP may lead to strength measures to improve adherence or to increase the dose of thiopurines. Moreover, some evidence suggests that medical supervision based on the routine determination of thiopurine metabolites may improve adherence to therapy, and therefore result in better outcomes 59 60…”

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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“…Such an approach also facilitates determination of adherence to therapy . Identification and subsequent counseling of patients who are non‐adherent was shown by Stocco et al . to have positive outcomes, as reiterated in the recent HCQ in lupus studies …”

Section: Azathioprinementioning

confidence: 98%

“…showed that measurement of metabolites and use of a metabolite‐dosing algorithm facilitated appropriate dosing decisions, with 24% avoiding inappropriate dose escalation, and 87% of patients achieving better clinical outcomes . Such an approach also facilitates determination of adherence to therapy . Identification and subsequent counseling of patients who are non‐adherent was shown by Stocco et al .…”

Section: Azathioprinementioning

confidence: 99%

Optimizing the use of existing therapies in lupus

Croyle

Morand

2015

Int J of Rheum Dis

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The management of systemic lupus erythematosus (SLE) is complicated by heterogeneous clinical presentations, a lack of universally accepted tools for the measurement of disease activity and a lack of powerful, safe, specific targeted therapies. Current medical treatment of disease activity relies on glucocorticoids as well as agents including hydroxychloroquine (HCQ), mycophenolate mofetil (MMF) azathioprine (AZA), and less frequently cyclophosphamide. These agents are generally used in fixed, weight-based dosing regimens, and both incomplete response and adverse effects are common. An emerging literature in SLE and other inflammatory diseases in which these drugs are used suggests that improved patient outcomes could be achieved through a different approach to their use. Measurement of drug or metabolite concentrations has been shown in a number of studies to identify under-and over-dosing, predict efficacy and detect non-adherence to therapy, with positive associations between optimum drug or metabolite levels and improved outcomes. In this paper, we will review the literature regarding the measurement of HCQ, MMF, AZA and cyclophosphamide drug and metabolite levels in SLE and inflammatory disease, and make recommendations for future research that could facilitate improved outcomes for patients with SLE.

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“…Treatment of IBD with thiopurines is a long-term therapy and therefore it is at risk for non-adherence, which is considered an important determinant of treatment inefficacy, even in pediatric patients; the additional level of medical supervision given by this assay has been reported to improve adherence to medical treatment and consequently the response to therapy [78,79].…”

Section: Pharmacokinetic Assays For Thiopurines: Measurement Of Azathmentioning

confidence: 99%

Personalized Therapies in Pediatric Inflammatory and Autoimmune Diseases

Stocco

Iudicibus

Franca

et al. 2012

CPD

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Pediatric inflammatory and autoimmune diseases are a wide array of systemic or organ-specific conditions, characterized by an exaggerated immune reactivity, which generally occurs in immunogenetically predisposed children. Among the most important ones, in terms of their diffusion and morbidity in the population worldwide, pediatric inflammatory bowel disease (IBD) and juvenile rheumatoid arthritis (JRA) have to be considered. The aim of personalized therapy is to give to each patient the most appropriate drug and dose regimen, in order to maximize treatment response and reduce the risk of adverse events. In general, several therapeutic options exist for pediatric inflammatory and autoimmune conditions, therefore the perspective of pharmacological tools that allow identification of patients with increased risk of treatment issues related to a particular medication, in terms of lack of efficacy or increased probability of adverse events, is particularly desirable and promising. The present review will be focused on the personalized therapy approaches already available or in development for pediatric patients with IBD or JRA, comprising pharmacokinetic, pharmacodynamic and pharmacogenetic assays.

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Usefulness of the measurement of azathioprine metabolites in the assessment of non-adherence

Cited by 22 publications

References 17 publications

Monitoring thiopurine metabolites in inflammatory bowel disease

Monitoring thiopurine metabolites in inflammatory bowel disease

Optimizing the use of existing therapies in lupus

Personalized Therapies in Pediatric Inflammatory and Autoimmune Diseases

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