Journal article
Role of Thiopurine Metabolite Testing and Thiopurine Methyltransferase Determination in Pediatric IBD
Journal of pediatric gastroenterology and nutrition, Vol.56(3), pp.333-340
2013
DOI: 10.1097/MPG.0b013e3182844705
PMID: 23287804
Abstract
Thiopurines have been used in inflammatory bowel disease (IBD) for >30 years, and measurements of both thiopurine methyltransferase (TPMT) and thiopurine (TP) metabolites, 6-thioguanine nucleotides (6-TGN) and 6-methylmercaptopurine (6-MMP), have been readily available. The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) Committee on Inflammatory Bowel Disease thought it appropriate to review the present indications for use of TPMT and TP metabolite testing. Substantial evidence demonstrates that TP therapy is useful for both Crohn disease and ulcerative colitis. Review of the existing data yielded the following recommendations. TPMT testing is recommended before initiation of TPs to identify individuals who are homozygote recessive or have extremely low TPMT activity, with the latter having more reliability than the former. Individuals who are homozygous recessive or have extremely low TPMT activity should avoid the use of TPs because of concerns for significant leukopenia. TMPT testing does not predict all cases of leukopenia and has no value to predict hypersensitivity adverse effects such as pancreatitis. Any potential value to reduce the risk of malignancy has not been studied. All individuals taking TPs should have routine monitoring with complete blood cell count and white blood cell count differential to evaluate for leukopenia regardless of TPMT testing results. Metabolite testing can be used to determine adherence with TP therapy. Metabolite testing can be used to guide dose increases or modifications in patients with active disease. Consideration would include either increasing the dose, changing therapy or for those with elevated transaminases or an elevated 6-MMP, using adjunctive allopurinol to help raise 6-thioguanine metabolites and suppress formation of 6-MMP. Routine and repetitive metabolite testing has little or no role in patients who are doing well and taking an acceptable dose of a TP.
Details
- Title: Subtitle
- Role of Thiopurine Metabolite Testing and Thiopurine Methyltransferase Determination in Pediatric IBD
- Creators
- Keith BENKOV - Mount Sinai School of Medicine, New York, NY, United StatesYING LU - Cohen Children's Medical Center of New York, Lake Success, United StatesAshish PATEL - Children's Medical Center of Dallas, Dallas, TX, United StatesRiad RAHHAL - University of Iowa, Iowa City, United StatesGary RUSSELL - MassGeneral Hospital for Children, Harvard Medical School, Boston, United StatesJonathan TEITELBAUM - Drexel University School of Medicine, Philadelphia, PA, United StatesNASPGHAN Committee on Inflammatory Bowel Disease
- Resource Type
- Journal article
- Publication Details
- Journal of pediatric gastroenterology and nutrition, Vol.56(3), pp.333-340
- Publisher
- Lippincott Williams & Wilkins
- DOI
- 10.1097/MPG.0b013e3182844705
- PMID
- 23287804
- ISSN
- 0277-2116
- eISSN
- 1536-4801
- Language
- English
- Date published
- 2013
- Academic Unit
- Stead Family Department of Pediatrics; Gastroenterology, Hepatology, Pancreatology, and Nutrition
- Record Identifier
- 9984093218302771
Metrics
18 Record Views