PMID- 36262537
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20221021
IS  - 2397-9070 (Electronic)
IS  - 2397-9070 (Linking)
VI  - 6
IP  - 10
DP  - 2022 Oct
TI  - Clinical utility of thiopurine metabolite monitoring in inflammatory bowel 
      disease and its impact on healthcare utilization in Singapore.
PG  - 658-666
LID - 10.1002/jgh3.12798 [doi]
AB  - BACKGROUND AND AIM: Thiopurines are recommended for maintenance of steroid-free 
      remission (SFR) in inflammatory bowel disease (IBD). Thiopurine metabolite 
      monitoring (MM) is increasingly used in the West but remains novel in Singapore, 
      with limited information on its therapeutic and economic benefits. Hence, this 
      study aims to investigate MM's clinical utility and its impact on healthcare 
      resource utilization in Singaporean IBD patients. METHODS: A retrospective 
      observational study was conducted at Singapore General Hospital outpatient IBD 
      Centre. Patients with IBD, baseline MM during 2014-2017, and weight-based 
      thiopurine doses for >/=4 weeks were followed up for 1 year. Actions were taken to 
      optimize therapy, and metabolite levels before and after the first action were 
      documented. Outcomes assessed included SFR, no therapy escalation or surgery, 
      healthcare resource utilization, and direct healthcare costs. RESULTS: Ninety IBD 
      patients (50 Crohn's disease, 40 ulcerative colitis) were included. Among them, 
      40% had baseline metabolite levels within therapeutic range, 31.1% 
      sub-therapeutic, 21.1% supra-therapeutic, and 7.8% shunters. Repeated MM with 
      subsequent dose optimization helped 67.2% of patients achieve therapeutic levels 
      after 1 year. Overall, 87.8% of patients achieved SFR and 90% had no therapy 
      escalation or surgery. Despite greater outpatient visits and laboratory 
      investigations with MM, the median total healthcare costs at 1 year only 
      increased marginally (S$6407.66 [shunters] vs S$5215.20 [supra-therapeutic] vs 
      S$4970.80 [sub-therapeutic] vs S$4370.48 [control (within therapeutic range)], 
      P = 0.592). CONCLUSION: MM guided timely therapy escalation for non-responders, 
      identification of non-adherence, and reversal of shunting. Therefore, it is a 
      useful clinical tool to optimize thiopurines without significantly increasing 
      healthcare costs.
CI  - (c) 2022 The Authors. JGH Open published by Journal of Gastroenterology and 
      Hepatology Foundation and John Wiley & Sons Australia, Ltd.
FAU - Yeo, Jia Qi
AU  - Yeo JQ
AD  - National Healthcare Group Pharmacy Singapore.
FAU - Cheen, Hua Heng McVin
AU  - Cheen HHM
AD  - Department of Pharmacy Singapore General Hospital Singapore.
FAU - Wong, Amanda
AU  - Wong A
AUID- ORCID: 0000-0002-3734-1381
AD  - Department of Pharmacy Singapore General Hospital Singapore.
FAU - Lim, Teong Guan
AU  - Lim TG
AD  - Department of Pharmacy Singapore General Hospital Singapore.
FAU - Chowbay, Balram
AU  - Chowbay B
AD  - Clinical Pharmacology Laboratory National Cancer Centre Singapore Singapore.
AD  - Centre for Clinician-Scientist Development Duke-NUS Medical School Singapore.
AD  - Singapore Immunology Network (SIgN) ASTAR (Agency for Science, Technology and 
      Research), Biopolis Singapore.
FAU - Leong, Wai Fook
AU  - Leong WF
AD  - Singapore Immunology Network (SIgN) ASTAR (Agency for Science, Technology and 
      Research), Biopolis Singapore.
FAU - Wang, Chunyan
AU  - Wang C
AD  - Clinical Pharmacology SingHealth Singapore.
FAU - Salazar, Ennaliza
AU  - Salazar E
AD  - Department of Gastroenterology and Hepatology Singapore General Hospital 
      Singapore.
FAU - Chan, Webber Pak Wo
AU  - Chan WPW
AD  - Department of Gastroenterology and Hepatology Singapore General Hospital 
      Singapore.
FAU - Kong, San Choon
AU  - Kong SC
AD  - Department of Gastroenterology and Hepatology Sengkang General Hospital 
      Singapore.
FAU - Ong, Wan Chee
AU  - Ong WC
AD  - Department of Pharmacy Singapore General Hospital Singapore.
LA  - eng
PT  - Journal Article
DEP - 20220801
PL  - Australia
TA  - JGH Open
JT  - JGH open : an open access journal of gastroenterology and hepatology
JID - 101730833
PMC - PMC9575318
OTO - NOTNLM
OT  - Crohn's disease
OT  - inflammatory bowel disease
OT  - metabolite monitoring
OT  - thiopurine
OT  - ulcerative colitis
EDAT- 2022/10/21 06:00
MHDA- 2022/10/21 06:01
PMCR- 2022/08/01
CRDT- 2022/10/20 02:37
PHST- 2022/04/27 00:00 [received]
PHST- 2022/07/01 00:00 [revised]
PHST- 2022/07/10 00:00 [accepted]
PHST- 2022/10/20 02:37 [entrez]
PHST- 2022/10/21 06:00 [pubmed]
PHST- 2022/10/21 06:01 [medline]
PHST- 2022/08/01 00:00 [pmc-release]
AID - JGH312798 [pii]
AID - 10.1002/jgh3.12798 [doi]
PST - epublish
SO  - JGH Open. 2022 Aug 1;6(10):658-666. doi: 10.1002/jgh3.12798. eCollection 2022 
      Oct.