Thiopurine metabolite measurement leads to changes in management of Inflammatory Bowel Disease.
Summary of "Thiopurine metabolite measurement leads to changes in management of Inflammatory Bowel Disease."
BACKGROUND:
The thiopurines azathioprine and 6-mercaptopurine are recommended for maintenance of remission in inflammatory bowel disease (IBD). Measurement of concentrations of the metabolites 6TGN and 6MMP helps delineate inter-individual variation in metabolism that may underlie variability in efficacy and toxicity.
AIMS:
We aimed to perform a retrospective observational study to determine the utility of thiopurine metabolite testing following its introduction into South Australia.
METHODS:
All patients having thiopurine metabolite tests done at Flinders Medical Centre between November 2008 and January 2010 were identified. Casenotes of patients with testing done in the context of treatment for IBD were interrogated to determine the reason for testing, clinical context and outcome.
RESULTS:
151 patients were identified with thiopurine metabolite testing for IBD with 157 testing episodes. 80 (51.0%) had testing done for flare or inefficacy, 18 (11.5%) for adverse effects, 5 (3.2%) for a combination of inefficacy and adverse effects and 54 (34.4%) for routine or other reasons. Testing was followed by improved outcomes of increased efficacy, reduced toxicity, or change to alternative therapy in 55.0% of the inefficacy/flare group, 27.8% of the suspected adverse reaction group, 60.0% of the combination group, and 13.0% of the routine/other group. Allopurinol was used as co-therapy in 16 patients, and led to marked improvements in metabolite concentrations.
CONCLUSIONS:
Thiopurine metabolite testing has quickly become established in South Australia. When used for inefficacy or adverse effects, it often leads to improved outcomes. Prospective studies are needed to determine whether routine testing to guide dosing is of benefit.
Affiliation
Gastrointestinal Unit, Centre for Molecular Medicine, MRC IGMM, University of Edinburgh, Western General Hospital, Edinburgh, EH4 2XU, UK; Department of Gastroenterology, Flinders Medical Centre, Bedford Park, SA 5042, Australia. nick.kennedy@ed.ac.uk.
Journal Details
This article was published in the following journal.
Name: Internal medicine journal
ISSN: 1445-5994
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/22946880
- DOI: http://dx.doi.org/10.1111/j.1445-5994.2012.02936.x
Medical and Biotech [MESH] Definitions
Sulfasalazine
A drug that is used in the management of inflammatory bowel diseases. Its activity is generally considered to lie in its metabolic breakdown product, 5-aminosalicylic acid (see MESALAMINE) released in the colon. (From Martindale, The Extra Pharmacopoeia, 30th ed, p907)
Mesalamine
An anti-inflammatory agent, structurally related to the SALICYLATES, which is active in INFLAMMATORY BOWEL DISEASE. It is considered to be the active moiety of SULPHASALAZINE. (From Martindale, The Extra Pharmacopoeia, 30th ed)
Pelvimetry
Measurement of the dimensions and capacity of the pelvis. It includes cephalopelvimetry (measurement of fetal head size in relation to maternal pelvic capacity), a prognostic guide to the management of LABOR, OBSTETRIC associated with disproportion.
Leukocyte L1 Antigen Complex
A member of the S-100 protein family that is present at high levels in the blood and interstitial fluid in several infectious, inflammatory, and malignant disorders, including rheumatoid arthritis, inflammatory bowel disease, and cystic fibrosis. It is a complex of a light chain (CALGRANULIN A) and a heavy chain (CALGRANULIN B). L1 binds calcium through an EF-hand motif, and has been shown to possess antimicrobial activity.
Echogenic Bowel
A PRENATAL ULTRASONOGRAPHY finding of excessively dense fetal bowel due to MECONIUM buildup.
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