PMID- 21351210
OWN - NLM
STAT- MEDLINE
DCOM- 20120516
LR  - 20180913
IS  - 1536-4844 (Electronic)
IS  - 1078-0998 (Linking)
VI  - 17
IP  - 12
DP  - 2011 Dec
TI  - Use of thiopurine testing in the management of inflammatory bowel diseases in 
      clinical practice: a worldwide survey of experts.
PG  - 2480-7
LID - 10.1002/ibd.21662 [doi]
AB  - BACKGROUND: We performed a worldwide survey to evaluate the extent to which 
      gastroenterologists who are experts in the field of inflammatory bowel diseases 
      (IBDs) are utilizing thiopurine metabolism in practice. METHODS: This was a 
      Web-based cross-sectional survey consisting of 12 multiple-choice and open-ended 
      questions. RESULTS: Between December 2009 and April 2010, 175 questionnaires were 
      received. The proportion of practitioners with access and reimbursement for 
      thiopurine S-methyltransferase (TPMT) genotype, TPMT phenotype, 6-thioguanine 
      nucleotides (6-TGN) levels, and 6-methylmercaptopurine ribonucleotides (6-MMP) 
      levels was 48%, 54%, 44%, and 35%, respectively. Before azathioprine initiation, 
      TPMT genotype and phenotype were performed by only 30% and 43% of responders, 
      respectively. In patients on thiopurine therapy, 6-TGN and 6-MMP levels were 
      determined by 54% and 44% of responders, respectively. Only 27% of physicians 
      always wait for TMPT activity/genotype results before initiating azathioprine and 
      81% do not routinely recheck metabolite levels after dose escalation or 
      reduction. In cases of very high or low TPMT activity, 75% and 74% of 
      practitioners take into account TMPT activity result, respectively. If access to 
      all azathioprine metabolite measurements was available and if all these tests 
      were reimbursed by public health insurance, 47% of responders would use these 
      tests more often in their practice. The availability and reimbursement of TPMT 
      status and azathioprine metabolites strongly influenced experts' attitudes. 
      CONCLUSIONS: Thiopurine testing is relatively underutilized by IBD 
      gastroenterologists. The availability and reimbursement of TPMT status and 
      azathioprine metabolites strongly influence the management of IBD patients 
      treated with thiopurines.
CI  - Copyright (c) 2011 Crohn's & Colitis Foundation of America, Inc.
FAU - Roblin, Xavier
AU  - Roblin X
AD  - Department of Hepato-Gastroenterology, University Hospital of Saint-Etienne, 
      Saint-Etienne, France.
FAU - Oussalah, Abderrahim
AU  - Oussalah A
FAU - Chevaux, Jean-Baptiste
AU  - Chevaux JB
FAU - Sparrow, Miles
AU  - Sparrow M
FAU - Peyrin-Biroulet, Laurent
AU  - Peyrin-Biroulet L
LA  - eng
PT  - Journal Article
DEP - 20110223
PL  - England
TA  - Inflamm Bowel Dis
JT  - Inflammatory bowel diseases
JID - 9508162
RN  - 0 (Biomarkers)
RN  - 6V404DV25O (6-methylthiopurine)
RN  - E7WED276I5 (Mercaptopurine)
RN  - EC 2.1.1.- (Methyltransferases)
RN  - EC 2.1.1.67 (thiopurine methyltransferase)
RN  - MRK240IY2L (Azathioprine)
SB  - IM
MH  - Azathioprine/*administration & dosage
MH  - Biomarkers/analysis
MH  - Cross-Sectional Studies
MH  - *Gastroenterology
MH  - *Genetic Testing
MH  - Genotype
MH  - Global Health
MH  - Humans
MH  - Inflammatory Bowel Diseases/diagnosis/*drug therapy/genetics
MH  - Mercaptopurine/administration & dosage/*analogs & derivatives
MH  - Methyltransferases/*genetics
MH  - Phenotype
MH  - *Practice Patterns, Physicians'
MH  - Surveys and Questionnaires
EDAT- 2011/02/26 06:00
MHDA- 2012/05/17 06:00
CRDT- 2011/02/26 06:00
PHST- 2010/12/18 00:00 [received]
PHST- 2010/12/31 00:00 [accepted]
PHST- 2011/02/26 06:00 [entrez]
PHST- 2011/02/26 06:00 [pubmed]
PHST- 2012/05/17 06:00 [medline]
AID - 10.1002/ibd.21662 [doi]
PST - ppublish
SO  - Inflamm Bowel Dis. 2011 Dec;17(12):2480-7. doi: 10.1002/ibd.21662. Epub 2011 Feb 
      23.