Evidence map›Paper›PMID 33821842›Full record

ArticleClinical and translational gastroenterology2021

Pretreatment HLADQA1-HLADRB1 Testing for the Prevention of Azathioprine-Induced Pancreatitis in Inflammatory Bowel Disease: A Prospective Cohort Study.

Aze Wilson, Qian Wang, Yun-Hee Choi, Terry Ponich, James C Gregor, Nilesh Chande, Brian Yan, Michael Sey, Melanie Beaton, Richard B Kim

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Clinical and translational gastroenterology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 2 pooled it
1.7field-weighted citation impact, top 17% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 2 syntheses or guidelines pooled it, 10 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Article
  5. Review
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 1 institution in 1 country.

Aze WilsonDivision of Clinical Pharmacology, Department of Medicine, Western University, London, Ontario, Canada.
Qian WangSchulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Yun-Hee ChoiDepartment of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
Terry PonichDivision of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada.
James C GregorDivision of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada.
Nilesh ChandeDivision of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada.
Brian YanDivision of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada.
Michael SeyDivision of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada.
Melanie BeatonDivision of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada.
Richard B KimDivision of Clinical Pharmacology, Department of Medicine, Western University, London, Ontario, Canada.
Western University · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionAzathioprine-induced pancreatitis is an idiosyncratic and unpredictable response, occurring in up to 7% of azathioprine-exposed patients with inflammatory bowel disease (IBD). The haplotype HLADQA1-HLADRB1*07:01A>C is strongly associated with azathioprine-induced pancreatitis in IBD. We aimed to evaluate whether pretreatment HLADQA1-HLADRB1*07:01A>C screening will reduce the risk of azathioprine-induced pancreatitis.

methodsParticipants with IBD were screened for HLADQA1-HLADRB1*07:01A>C, and participants with a variant genotype were excluded from azathioprine treatment. Wild-type participants were started on azathioprine and followed for 3 months. The incidence of pancreatitis was compared with unscreened historical controls.

resultsHLADQA1-HLADRB1*07:01A>C screening resulted in an 11-fold reduction in the incidence of azathioprine-induced pancreatitis (n = 1/328 or 0.30% vs n = 13/373 or 3.4%). In propensity score-matched cohorts (age and sex), HLA DQA1-HLADRB1*07:01A>C screening was significantly associated with a reduction in the incidence of AZA-induced pancreatitis independent of weight, glucocorticoid exposure, and smoking status (adjusted odds ratio = 0.075, 95% confidence interval = 0.01-0.58, P = 0.01). Up to 45% (n = 271/599) of participants were excluded from azathioprine therapy based on the haplotype in the HLADQA1-HLADRB1*07:01A>C-screened cohort. DISCUSSION: HLADQA1-HLADRB1*07:01A>C screening reduced the risk of azathioprine-induced pancreatitis; however, using this strategy to guide the use of azathioprine therapy in IBD may eliminate a large proportion of patients from being eligible for treatment with azathioprine. In regions where there is access to other IBD therapies, and given the short-term and long-term toxicities associated with azathioprine, HLADQA1-HLADRB1*07:01A>C-screening may be a clinically relevant strategy for enhancing the safe use of azathioprine in IBD. In addition, cost-effectiveness analyses are needed to further solidify the utility of HLADQA1-HLADRB1*07:01A>C screening in IBD populations.

Indexed as

Polymorphism, GeneticAzathioprineHaplotypesHLA-DQ alpha-ChainsHLA-DRB1 ChainsHumansImmunosuppressive AgentsInflammatory Bowel DiseasesPancreatitisPropensity ScoreProspective StudiesAzathioprineHLA-DQA1 antigenHLA-DQ alpha-ChainsHLA-DRB1 ChainsImmunosuppressive Agents

Identifiers

PMID33821842
PMCPMC8345912
OpenAlexW3134534077

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.