Successful Azathioprine Treatment with Metabolite Monitoring in a Pediatric Inflammatory Bowel Disease Patient Homozygous for TPMT*3Copen access
- Authors
- Lee, MN[Lee, Mi-Na]; Woo, HI[Woo, Hye In]; Lee, YM[Lee, Yoo Min]; Kang, B[Kang, Ben]; Kim, JW[Kim, Jong-Won]; Choe, YH[Choe, Yon Ho]; Lee, SY[Lee, Soo-Youn]
- Issue Date
- 1-Nov-2013
- Publisher
- YONSEI UNIV COLLEGE MEDICINE
- Keywords
- Thiopurine methyltransferase; azathioprine; inflam
- Citation
- YONSEI MEDICAL JOURNAL, v.54, no.6, pp.1545 - 1549
- Indexed
- SCIE
SCOPUS
KCI
- Journal Title
- YONSEI MEDICAL JOURNAL
- Volume
- 54
- Number
- 6
- Start Page
- 1545
- End Page
- 1549
- URI
- https://scholarworks.bwise.kr/skku/handle/2021.sw.skku/58593
- DOI
- 10.3349/ymj.2013.54.6.1545
- ISSN
- 0513-5796
- Abstract
- Thiopurine S-methyltransferase (TPMT) methylates purine analogues, showing TPMT activity in inverse relation to concentrations of active metabolites such as 6-thioguanine nucleotide (6-TGN). With conventional dosing of thiopurines, patients with homozygous variant TPMT alleles consistently suffer from severe myelosuppression. Here, we report a patient with TPMT*3C/*3C who managed successfully with monitoring of thiopurine metabolites. The patient was an 18-year-old male diagnosed with Crohn's disease. The standard dose of azathioprine (AZA) (1.8 mg/kg/day) with mesalazine (55.6 mg/kg/day) was prescribed. Two weeks after starting AZA treatment, the patient developed leukopenia. The DNA sequence analysis of TPMT identified a homozygous missense variation (NM_000367.2: c.719A>G; p.Tyr240Cys), TPMT*3C/*3C. He was treated with adjusted doses of azathioprine (0.1-0.2 mg/kg/day) and his metabolites were closely monitored. Leukopenia did not reoccur during the follow-up period of 24 months. To our knowledge, this is the first case of a patient homozygous for TPMT*3C successfully treated with azathioprine in Korea. While a TPMT genotyping test may be helpful to determine a safe starting dose, it may not completely prevent myelosuppression. Monitoring metabolites as well as routine laboratory tests can contribute to assessing drug metabolism and optimizing drug dosing with minimized drug-induced toxicity
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- Appears in
Collections - Medicine > Department of Medicine > 1. Journal Articles
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