title: Getting the best out of thiopurine therapy: thiopurine S-methyltransferase and beyond.
abstract: Thiopurines are the cornerstone of treatment for a wide variety of medical disorders, ranging from pediatric leukemia to inflammatory bowel disease. Because of their complex metabolism and potential toxicities, the use of biomarkers to predict risk and response is paramount. Thiopurine S-methyltransferase and thiopurine metabolite levels have emerged as companion diagnostics with crucial roles in facilitating safe and effective treatment. This review serves to update the reader on how these tools are being developed and implemented in clinical practice. A useful paradigm in thiopurine therapeutic strategy is presented, along with fresh insights into the mechanisms underlying these approaches. We elaborate on potential future developments in the optimization of thiopurine therapy.
authors.affiliation: Department of Gastroenterology, St Thomas Hospital, Westminster Bridge Road, London, UK.
authors.forename: Steven Chung Ming
authors.initials: SC
authors.lastname: Fong
authors.forename: Paul Andrew
authors.initials: PA
authors.lastname: Blaker
authors.forename: Monica
authors.initials: M
authors.lastname: Arenas-Hernandez
authors.forename: Anthony Marin
authors.initials: AM
authors.lastname: Marinaki
authors.forename: Jeremy David
authors.initials: JD
authors.lastname: Sanderson
mesh_terms: D000493:Allopurinol / Q000378:metabolism / Q000627:therapeutic use; D015415:Biomarkers / Q000378:metabolism; D004359:Drug Therapy, Combination; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology; D007938:Leukemia / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology; D015122:Mercaptopurine / Q000737:chemistry / Q000378:metabolism* / Q000627:therapeutic use; D008780:Methyltransferases / Q000737:chemistry / Q000235:genetics / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D007166:Immunosuppressive Agents; D000493:Allopurinol; D015122:Mercaptopurine; D008780:Methyltransferases; C022745:thiopurine methyltransferase
keywords: 6-mercaptopurine; IBD; allopurinol; azathioprine; drug metabolism; metabolite testing; pharmacogenetics; therapeutic drug monitoring; thiopurine methyltransferase; thiopurines