title: Erythrocyte thiopurine methyl transferase assessment prior to azathioprine use in the UK.
abstract: BACKGROUND
  Individuals with low activity of a key metabolic enzyme, thiopurine methyl transferase (TPMT), are more susceptible to azathioprine-induced myelosuppression.
  
  
  OBJECTIVE
  To determine the pattern of use of TPMT activity estimation, with respect to azathioprine use, by medical practitioners in the UK.
  
  
  METHODS
  Retrospective analysis of assay use.
  
  
  METHODS
  We analysed all test results (n=3291), and patient and practitioner details, from inception of TPMT assay in 1990 to the end of December 2000, held at the Purine Research Laboratory, Guy's Hospital, London. Patient details were anonymized. Repeat analyses and requests from outside the UK were excluded.
  
  
  RESULTS
  The male:female ratio was approximately equal and the mean age was 46.6 (range 0.5-97) years. Thirteen different medical specialities requested assays; Dermatology and Gastroenterology were the most frequent users, together accounting for 86% of requests. The numbers of centres requesting the assay varied widely both within and between different specialities. Some 80% of individuals had normal TPMT activity, 9% enzymic activity above normal, and 10% low activity. Fifteen had no detectable enzymic activity: 0.45% (1:220) of the study population.
  
  
  CONCLUSIONS
  This incidence of undetectable enzyme activity is significantly higher than the previously reported level of 1:300 derived from smaller studies, and makes the economics of screening more attractive.
authors.affiliation: Department of Dermatology, Royal Gwent Hospital, Newport, Purine Research Laboratory and Department of Gastroenterology, Guy's & St Thomas' Hospitals Trust, London, UK. saholme@hotmail.com
authors.forename: S A
authors.initials: SA
authors.lastname: Holme
authors.forename: J A
authors.initials: JA
authors.lastname: Duley
authors.forename: J
authors.initials: J
authors.lastname: Sanderson
authors.forename: P A
authors.initials: PA
authors.lastname: Routledge
authors.forename: A V
authors.initials: AV
authors.lastname: Anstey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001379:Azathioprine / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004912:Erythrocytes / Q000201:enzymology*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007223:Infant; D008297:Male; D008780:Methyltransferases / Q000032:analysis*; D008875:Middle Aged; D012189:Retrospective Studies; D006113:United Kingdom
chemical_list: D007166:Immunosuppressive Agents; D008780:Methyltransferases; C022745:thiopurine methyltransferase; D001379:Azathioprine