PMID- 23287804
OWN - NLM
STAT- MEDLINE
DCOM- 20130827
LR  - 20220410
IS  - 1536-4801 (Electronic)
IS  - 0277-2116 (Linking)
VI  - 56
IP  - 3
DP  - 2013 Mar
TI  - Role of thiopurine metabolite testing and thiopurine methyltransferase 
      determination in pediatric IBD.
PG  - 333-40
LID - 10.1097/MPG.0b013e3182844705 [doi]
AB  - 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.
FAU - Benkov, Keith
AU  - Benkov K
AD  - Mount Sinai School of Medicine, New York, NY 10029, USA. keith.benkov@mssm.edu
FAU - Lu, Ying
AU  - Lu Y
FAU - Patel, Ashish
AU  - Patel A
FAU - Rahhal, Riad
AU  - Rahhal R
FAU - Russell, Gary
AU  - Russell G
FAU - Teitelbaum, Jonathan
AU  - Teitelbaum J
CN  - NASPGHAN Committee on Inflammatory Bowel Disease
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - J Pediatr Gastroenterol Nutr
JT  - Journal of pediatric gastroenterology and nutrition
JID - 8211545
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
RN  - 0 (Purines)
RN  - 0 (Sulfhydryl Compounds)
RN  - 0 (Thionucleosides)
RN  - EC 2.1.1.- (Methyltransferases)
RN  - EC 2.1.1.67 (thiopurine methyltransferase)
RN  - Pediatric Crohn's disease
RN  - Pediatric ulcerative colitis
SB  - IM
EIN - J Pediatr Gastroenterol Nutr. 2013 May;56(5):582
MH  - Anti-Inflammatory Agents, Non-Steroidal/adverse 
      effects/blood/*pharmacokinetics/therapeutic use
MH  - Biotransformation
MH  - Colitis, Ulcerative/blood/*drug therapy/metabolism
MH  - Consensus
MH  - Crohn Disease/blood/*drug therapy/metabolism
MH  - Drug Interactions
MH  - Drug Monitoring
MH  - Evidence-Based Medicine
MH  - Humans
MH  - Inflammatory Bowel Diseases/blood/drug therapy/metabolism
MH  - Methyltransferases/blood/*metabolism
MH  - Practice Guidelines as Topic
MH  - Purines/adverse effects/blood/*pharmacokinetics/therapeutic use
MH  - Societies, Scientific
MH  - Sulfhydryl Compounds/adverse effects/blood/*pharmacokinetics/therapeutic use
MH  - Thionucleosides/adverse effects/blood/*pharmacokinetics/therapeutic use
EDAT- 2013/01/05 06:00
MHDA- 2013/08/28 06:00
CRDT- 2013/01/05 06:00
PHST- 2013/01/05 06:00 [entrez]
PHST- 2013/01/05 06:00 [pubmed]
PHST- 2013/08/28 06:00 [medline]
AID - 10.1097/MPG.0b013e3182844705 [doi]
PST - ppublish
SO  - J Pediatr Gastroenterol Nutr. 2013 Mar;56(3):333-40. doi: 
      10.1097/MPG.0b013e3182844705.