Abstract
Start Low, Go Slow, but Don’t Go This Way yet
Highlights
Azathioprine (AZA) and 6-mercaptopurine (6-MP) are critical medications with proven benefits and an acceptable safety profile, used in both Crohn’s disease and ulcerative colitis (1-4)
Because AZA/6-MP is important for treating patients with inflammatory bowel disease, much research has focused on how to achieve optimal clinical efficacy while minimizing complications (6,10-16)
The absence of prospective randomized trials addressing the utility of metabolite testing in patients on AZA/6-MP, the limited availability of these tests and the cost of these investigations are the major reasons why Canadian gastroenterologists are not routinely using these tests to optimize management of patients with inflammatory bowel disease on AZA/6-MP
Summary
Azathioprine (AZA) and 6-mercaptopurine (6-MP) are critical medications with proven benefits and an acceptable safety profile, used in both Crohn’s disease and ulcerative colitis (1-4). Because AZA/6-MP is important for treating patients with inflammatory bowel disease, much research has focused on how to achieve optimal clinical efficacy while minimizing complications (6,10-16). As recommended by the US Food and Drug Administration, some gastroenterologists are using pharmacogenetics to identify patients with specific genetic mutations that result in low TPMT enzymatic activity, which may predict hematological toxicity from AZA/6-MP (17-22).
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