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Thiopurine response

MedGen UID:
1609699
Concept ID:
CN971394
Sign or Symptom
Drug:
Thiopurine
MedGen UID:
1720699
Concept ID:
C0597573
 
Related genes: NUDT15, TPMT

Additional description

From PharmGKB
The thiopurines include azathioprine (a pro-drug for mercaptopurine), mercaptopurine and thioguanine. They are used to treat a variety of immunological disorders such as rheumatoid arthritis, non- Hodgkin lymphoma and ulcerative colitis. Both mercaptopurine and thioguanine can exert cytotoxic effects through the formation of thioguanine nucleotides (TGNs), active metabolites that incorporate into DNA. Mercaptopurine and thioguanine are directly inactivated by thiopurine S-methyltransferase (TPMT). Individuals with two nonfunctional TPMT alleles are at 100% risk of potentially fatal myelosuppression, due to an increased buildup of toxic TGNs. Alternative agents or a drastically reduced dose are recommended for patients with this genotype. Patients heterozygous for a nonfunctional TPMT allele are at increased risk of myelosuppression, and reduced dosing is recommended for these individuals. These dosing guidelines have been published in Clinical Pharmacology and Therapeutics by the Clinical Pharmacogenetics Implementation Consortium (CPIC) and are available on the PharmGKB website.  https://www.pharmgkb.org/chemical/PA356

Recent clinical studies

Etiology

Sluiter RL, Van Marrewijk C, De Jong D, Scheffer H, Guchelaar HJ, Derijks L, Wong DR, Hooymans P, Vermeulen SH, Verbeek ALM, Franke B, Van der Wilt GJ, Kievit W, Coenen MJH
J Crohns Colitis 2019 Jul 25;13(7):838-845. doi: 10.1093/ecco-jcc/jjz009. PMID: 30698675Free PMC Article
Broekman MMTJ, Coenen MJH, van Marrewijk CJ, Wanten GJA, Wong DR, Verbeek ALM, Klungel OH, Hooymans PM, Guchelaar HJ, Scheffer H, Derijks LJJ, de Jong DJ; TOPIC Recruitment Team
Inflamm Bowel Dis 2017 Oct;23(10):1873-1881. doi: 10.1097/MIB.0000000000001163. PMID: 28644183Free PMC Article
Bar-Yoseph H, Waterman M, Almog R, Billiet T, Vermeire S, Ungar B, Yanai H, Dotan I, Ben-Horin S, Chowers Y
Clin Gastroenterol Hepatol 2017 Jan;15(1):69-75. Epub 2016 Jul 9 doi: 10.1016/j.cgh.2016.06.028. PMID: 27404966
Bourgine J, Garat A, Allorge D, Crunelle-Thibaut A, Lo-Guidice JM, Colombel JF, Broly F, Billaut-Laden I
Pharmacogenet Genomics 2011 Jun;21(6):313-24. doi: 10.1097/FPC.0b013e3283449200. PMID: 21372752
Gardiner SJ, Gearry RB, Burt MJ, Chalmers-Watson T, Chapman BA, Ross AG, Stedman CA, Huelsen A, Barclay ML
J Gastroenterol Hepatol 2011 Jan;26(1):49-54. doi: 10.1111/j.1440-1746.2010.06489.x. PMID: 21175793

Diagnosis

Sluiter RL, Van Marrewijk C, De Jong D, Scheffer H, Guchelaar HJ, Derijks L, Wong DR, Hooymans P, Vermeulen SH, Verbeek ALM, Franke B, Van der Wilt GJ, Kievit W, Coenen MJH
J Crohns Colitis 2019 Jul 25;13(7):838-845. doi: 10.1093/ecco-jcc/jjz009. PMID: 30698675Free PMC Article
Hofmann U, Heinkele G, Angelberger S, Schaeffeler E, Lichtenberger C, Jaeger S, Reinisch W, Schwab M
Anal Chem 2012 Feb 7;84(3):1294-301. Epub 2012 Jan 25 doi: 10.1021/ac2031699. PMID: 22220820

Therapy

Chang JY, Cheon JH
Dig Dis Sci 2019 Sep;64(9):2395-2403. Epub 2019 Jul 9 doi: 10.1007/s10620-019-05720-5. PMID: 31290039
Sluiter RL, Van Marrewijk C, De Jong D, Scheffer H, Guchelaar HJ, Derijks L, Wong DR, Hooymans P, Vermeulen SH, Verbeek ALM, Franke B, Van der Wilt GJ, Kievit W, Coenen MJH
J Crohns Colitis 2019 Jul 25;13(7):838-845. doi: 10.1093/ecco-jcc/jjz009. PMID: 30698675Free PMC Article
Bar-Yoseph H, Waterman M, Almog R, Billiet T, Vermeire S, Ungar B, Yanai H, Dotan I, Ben-Horin S, Chowers Y
Clin Gastroenterol Hepatol 2017 Jan;15(1):69-75. Epub 2016 Jul 9 doi: 10.1016/j.cgh.2016.06.028. PMID: 27404966
Hofmann U, Heinkele G, Angelberger S, Schaeffeler E, Lichtenberger C, Jaeger S, Reinisch W, Schwab M
Anal Chem 2012 Feb 7;84(3):1294-301. Epub 2012 Jan 25 doi: 10.1021/ac2031699. PMID: 22220820
Gardiner SJ, Gearry RB, Burt MJ, Chalmers-Watson T, Chapman BA, Ross AG, Stedman CA, Huelsen A, Barclay ML
J Gastroenterol Hepatol 2011 Jan;26(1):49-54. doi: 10.1111/j.1440-1746.2010.06489.x. PMID: 21175793

Prognosis

Chang JY, Cheon JH
Dig Dis Sci 2019 Sep;64(9):2395-2403. Epub 2019 Jul 9 doi: 10.1007/s10620-019-05720-5. PMID: 31290039
Koifman E, Karban A, Mazor Y, Chermesh I, Waterman M, Almog R, Ben-Horin S, Eliakim R, Krivoy N, Efrati E, Chowers Y
Inflamm Bowel Dis 2013 Jul;19(8):1639-44. doi: 10.1097/MIB.0b013e31828828d3. PMID: 23669401

Clinical prediction guides

Chang JY, Cheon JH
Dig Dis Sci 2019 Sep;64(9):2395-2403. Epub 2019 Jul 9 doi: 10.1007/s10620-019-05720-5. PMID: 31290039
Sluiter RL, Van Marrewijk C, De Jong D, Scheffer H, Guchelaar HJ, Derijks L, Wong DR, Hooymans P, Vermeulen SH, Verbeek ALM, Franke B, Van der Wilt GJ, Kievit W, Coenen MJH
J Crohns Colitis 2019 Jul 25;13(7):838-845. doi: 10.1093/ecco-jcc/jjz009. PMID: 30698675Free PMC Article
Broekman MMTJ, Coenen MJH, Wanten GJ, van Marrewijk CJ, Kievit W, Klungel OH, Verbeek ALM, Wong DR, Hooymans PM, Guchelaar HJ, Scheffer H, Derijks LJJ, Bouvy ML, de Jong DJ
Eur J Gastroenterol Hepatol 2018 Feb;30(2):167-173. doi: 10.1097/MEG.0000000000001025. PMID: 29120908Free PMC Article
Bar-Yoseph H, Waterman M, Almog R, Billiet T, Vermeire S, Ungar B, Yanai H, Dotan I, Ben-Horin S, Chowers Y
Clin Gastroenterol Hepatol 2017 Jan;15(1):69-75. Epub 2016 Jul 9 doi: 10.1016/j.cgh.2016.06.028. PMID: 27404966
Koifman E, Karban A, Mazor Y, Chermesh I, Waterman M, Almog R, Ben-Horin S, Eliakim R, Krivoy N, Efrati E, Chowers Y
Inflamm Bowel Dis 2013 Jul;19(8):1639-44. doi: 10.1097/MIB.0b013e31828828d3. PMID: 23669401

Supplemental Content

Table of contents

    Clinical resources

    Practice guidelines

    • PubMed
      See practice and clinical guidelines in PubMed. The search results may include broader topics and may not capture all published guidelines. See the FAQ for details.

    Curated

    • NACB, 2010
      National Academy of Clinical Biochemistry, Clinical practice considerations. In: Laboratory medicine practice guidelines: guidelines and recommendations for laboratory analysis and application of pharmacogenetics to clinical practice, 2010

    Consumer resources

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