title: The role of thiopurine metabolite monitoring in inflammatory bowel disease.
abstract: Thiopurines are the mainstay of medical management in inflammatory bowel disease (IBD), especially in the maintenance of disease remission. Given the limited IBD armamentarium it is important to optimize each therapy before switching to an alternative drug. Conventional weight based dosing of thiopurines in IBD leads to intolerance or inefficacy in many patients. More recently increased knowledge of their metabolism has allowed for dose optimization using thiopurine metabolite levels, namely 6-thioguanine nucleotides and 6-methylmercaptopurine, with the potential for improved outcomes in patients with IBD. This review will outline the current understanding of thiopurine metabolism and pharmacogenomics and will describe the clinical application of this knowledge in the optimization of thiopurines in individual patients.
authors.affiliation: Department of Gastroenterology, Alfred Health and Monash University, Commercial Road, Melbourne, 3004 Victoria, Australia.
authors.forename: Lauren
authors.initials: L
authors.lastname: Beswick
authors.forename: Antony B
authors.initials: AB
authors.lastname: Friedman
authors.forename: Miles P
authors.initials: MP
authors.lastname: Sparrow
mesh_terms: D000493:Allopurinol / Q000493:pharmacokinetics / Q000627:therapeutic use; D000963:Antimetabolites / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001379:Azathioprine / Q000493:pharmacokinetics / Q000627:therapeutic use; D016903:Drug Monitoring / Q000379:methods*; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000378:metabolism; D015122:Mercaptopurine / Q000493:pharmacokinetics / Q000627:therapeutic use*; D008780:Methyltransferases / Q000378:metabolism
chemical_list: D000963:Antimetabolites; D000493:Allopurinol; D015122:Mercaptopurine; D008780:Methyltransferases; C022745:thiopurine methyltransferase; D001379:Azathioprine