DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20204109

Role of therapeutic drug monitoring of azathioprine and thiopurine methyltransferase enzyme status in patients with inflammatory bowel disease: Indian scenario

Maninder Singh, Sandeep Kaushal, Kanchan Gupta, Ajit Sood

Abstract


Inflammatory bowel disease is mainly caused by dysragulated immune system. Inflammatory bowel disease incidences are rising in Asian countries with difficulty in their diagnosis and managements. There is rising the incidences and prevalence rate in India. Inflammatory bowel disease has two major subtypes Ulcerative colitis and chron’s disease. In ulcerative colitis inflammation occurs in lower part of large intestine that extend from anal verge to proximal colon while in case of chron’s disease there is transmural inflammation of gastrointestinal tract. This review is to provide comprehensive review focused on the current status of therapeutic drug monitoring of azathioprine metabolites in patients of inflammatory bowel disease.


Keywords


Inflammatory bowel disease, Ulcerative colitis, Chron’s disease, Therapeutic drug monitoring, Azathioprine, 6-Methylmercaptopurine, 6-Thioguanine nucleotides

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References


Gearry RB, Barclay ML. Azathioprine and 6‐mercaptopurine pharmacogenetics and metabolite monitoring in inflammatory bowel disease. J Gastroentero Hepato. 2005;20(8):1149-57.

Haas A, Zimmermann K, Graw F, Slack E, Rusert P, Ledergerber B, et al. Systemic antibody responses to gut commensal bacteria during chronic HIV-1 infection. Gut. 2011;60(11):1506-19.

Moon W, Loftus Jr EV. recent advances in pharmacogenetics and pharmacokinetics for safe and effective thiopurine therapy in inflammatory bowel disease. Aliment pharmaco therapeut. 2016; 43(8):863-83.

Ray G. Inflammatory bowel disease in India changing paradigms. Int J Colorec Dise. 2011;26(5):635-44.

Lichtenstein GR. Advances in the Field of Gastroenterology and Hepatology. Gastroenter Hepato. 2016;12(4),209.

Sood A, Midha V, Sood N, Bhatia AS, Avasthi G. Incidence and prevalence of ulcerative colitis in Punjab, North India. Gut. 2003;52(11):1587-90.

Gastrointestinal Unit Medical Services MG, Andres PG, Friedman LS. Epidemiology and the natural course of inflammatory bowel disease. Gastroentero Clini Nor Ameri. 1999;28(2):255-81.

Lucendo, AJ. Hervías D, Roncero O, Lorente R, et al. Epidemiology and temporal trends (2000-2012) of inflammatory bowel disease in adult patients in a central region of Spain. Eur J Gastroenterol Hepatol. 2014;26:1399-1407.

Lovasz, BD. Golovics, PA. Vegh, Z. Lakatos, PL. New trends in inflammatory bowel disease epidemiology and disease course in Eastern Europe. Dig. Liver Dis. 2013;45:269-76.

Ray G. Inflammatory bowel disease in India-changing paradigms. Int J Colorectal. 2011;26: 635-44.

Khosla SN, Girdhar NK, Lal S, Mishra DS. Epidemiology of ulcerative colitis in hospital and select general population of northern India. J Assoc Physicia Ind. 1986;34: 405-7.

Sood A. Incidence and prevalence of ulcerative colitis in Punjab, North India. Gut, 2003;52(11):1587-90.

Makharia GK, Ramakrishna BS, Abraham P, Choudhuri G, Misra SP, Ahuja V, et al. Survey of inflammatory bowel diseases in India. Ind J Gastroentero. 2012;31(6): 299-306.

Probert CS, Mayberry JF, Mann R. Inflammatory bowel disease in the rural Indian subcontinent: a survey of patients attending mission hospitals. Digest. 1990;47(1):42-6.

Bruntton LL, Chabner BA, Knollmann BC, Goodmen, Gillmens, Pharmacological basis of therapeutics. Mac grew hills. 2010;12.

Harrison’s. Principles of internal meidine. McGraw –Hill. 2012;18.

Lennard L. The clinical pharmacology of 6-mp. Eur J Clin Pharmacol. 1992;43:329-39.

Nielsen OH, Vainer B, Rask- Madsen J. Review article: the treatment of inflammatory bowel disease with 6-mercaptopurine or azathioprine. Alim Pharmacol Ther. 2001;15(11):1699-1708.

Ray G. Inflammatory bowel disease in India-Past, present and future. World J Gastroentero. 2016; 22(36):8123.

Yang H, McElree C, Roth MP, Shanahan F, Targan SR, Rotter JI. Familial empirical risks for inflammatory bowel disease: differences between Jews and non-Jews. Gut 1993; 34:517-24.

Samir K. Brahmachari, Partha P. Majumder, Mitali Mukerji et. al. Genetic landscape of the people of India: a canvas for disease gene exploration. J Genet. 2008;87(1):3-20.

Weinshilboum, RM. Sladek, SL. Mercaptopurine pharmacogenetics: monogenic inheritance of erythrocyte thiopurine methyltransferase activity. Am J Hum Genet. 1980;32:651-62.

Krynetski E, Evans W. Genetic Polymorphism of Thiopurine S-Methyltransferase: Molecular Mechanisms and Clinical Importance. Pharmaco. 2000;61(3):136-46.

Cheung S Allan R. Mistaken identity misclassification of TPMT phenotype following blood transfusion. Europ J Gastroentero Hepato. 2003;15(11):1245-7.

Schwab M, Schaeffeler E, Marx C, Zanger U, Aulitzky W, Eichelbaum M. Shortcoming in the diagnosis of TPMT deficiency in a patient with Crohn's disease using phenotyping only. Gastroentero. 2001;121(2):500-1.

Lennard L, Cartwright CS, Wade R, Richards SM, Vora A. Thiopurine methyltransferase genotype–phenotype discordance and thiopurine active metabolite formation in childhood acute lymphoblastic leukaemia. Brits J Clinic Pharmaco. 2013;76(1):125-36.

Sheffield LJ, Irving P, Gupta A, Byron K, Macrae FA, Phillimore H, et al. Thiopurine methyltransferase and thiopurine metabolite testing in patients with inflammatory bowel disease who are taking thiopurine drugs. Pharmacogeno. 2009;10(7):1091-9.

Hande S, Wilson-Rich N, Bousvaros A. 5-aminosalicylate therapy is associated with higher 6-thioguanine levels in adults and children with inflammatory bowel disease in remission on 6-mercaptopurine or azathioprine. Inflamm Bowel Dis. 2006;12:251–7.

Moon W, Loftus Jr EV. recent advances in pharmacogenetics and pharmacokinetics for safe and effective thiopurine therapy in inflammatory bowel disease. Aliment Pharmaco Therapeut. 2016;43(8):863-83.

Deshpande AR, Abreu MT. Optimizing therapy with 6-mercaptopurine and azathioprine: to measure or not to measure?.

Chouchana L, Narjoz C, Beaune P, Loriot MA, Roblin X. the benefits of pharmacogenetics for improving thiopurine therapy in inflammatory bowel disease. Alimen Pharmaco Therapeut. 2012;35(1): 15-36.

Meijer B, Seinen ML, Van Egmond R, Bouma G, Mulder CJ, Van Bodegraven AA, et al. Optimizing thiopurine therapy in inflammatory bowel disease among 2 real-life intercept cohorts: effect of allopurinol comedication?. Inflammat Bow Diseas. 2017;23(11):2011-7.

Cuffari C, Seidman EG, Latour S, Theoret Y. Quantitation of 6-thioguanine in peripheral blood leukocyte DNA in Crohn's disease patients on maintenance 6-mercaptopurine therapy. Canad J Physio Pharmaco. 1996;74(5):580-5.

Cuffari C, Hunt S, Bayless T. Utilisation of erythrocyte 6-thioguanine metabolite levels to optimise azathioprine therapy in patients with inflammatory bowel disease. Gut. 2001;48(5):642-6.

Chrzanowska M, Kolecki P, Duczmal-Cichocka B, Fiet J. Metabolites of mercaptopurine in red blood cells: a relationship between 6-thioguanine nucleotides and 6-methylmercaptopurine metabolite concentrations in children with lymphoblastic leukemia. Europ J Pharmaceuti Scienc. 1999;8(4): 329-34.

Dubinsky MC, Lamothe S, Yang HY, Targan SR, Sinnett D, Théorêt Y, et al. Pharmacogenomics and metabolite measurement for 6-mercaptopurine therapy in inflammatory bowel disease. Gastroenter. 2000;118(4):705-13.

Melek Simsek, Berrie Meijer, Chris J. J. Mulder, et. al. Analytical Pitfalls of Therapeutic Drug Monitoring of Thiopurines in Patients With Inflammatory Bowel Disease. Ther Drug Monit. 2017;39:584-8.

Moreau AC, Paul S, Del Tedesco E, Rinaudo-Gaujous M, Boukhadra N, Genin C, et al. Association between 6-thioguanine nucleotides levels and clinical remission in inflammatory disease: a meta-analysis. Inflammat Bow Disea. 2014;20(3):464-71.

Osterman MT, Kundu R, Lichtenstein GR, Lewis JD. Association of 6-thioguanine nucleotide levels and inflammatory bowel disease activity: a meta-analysis. Gastroentero. 2006;130(4):1047-53.

Davavala SK, Desai DC, Abraham P, Ashavaid T, Joshi A, Gupta T. Prevalence of TPMT polymorphism in Indian patients requiring immunomodulator therapy and its clinical significance. Ind J Gastroentero. 2014;33(1):41-5.

Davavala SK, Desai DC, Abraham P, Ashavaid T, Joshi A, Gupta T. Prevalence of TPMT polymorphism in Indian patients requiring immunomodulator therapy and its clinical significance. Ind J Gastroentero. 2014;33(1):41-5.

Kumagai K, Hiyama K, Ishioka S, Sato H, Yamanishi Y, McLeod HL, et al. Allelotype frequency of the thiopurine methyltransferase (TPMT) gene in Japanese. Pharmacogen Genom. 2001;11(3):275-8.

Parkar SP, Dherai AJ, Desai DC, Ashavaid TF. Thiopurine metabolite level and toxicity in Indians with inflammatory bowel disease. J Gastroentero Hepato. 2017;1(1):25-31.