Evidence map›Paper›PMID 40421668›Full record

ArticleBritish journal of clinical pharmacology2025

The fate of thiopurine metabolites after switching to low-dose thiopurine with allopurinol or thioguanine in IBD patients: A retrospective analysis.

Ahmed B Bayoumy, Hedwig M A D'Agnolo, Nanne K H de Boer, Chris J J Mulder, Luc J J Derijks

Abstract read
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Article in British journal of clinical pharmacology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

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3 · Its place in the literature

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1 citing paper in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

5 authors.

Ahmed B BayoumyDepartment of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, The Netherlands.ORCID https://orcid.org/0000-0002-5302-9312
Hedwig M A D'AgnoloDepartment of Gastroenterology and Hepatology, Máxima Medical Center, Veldhoven, The Netherlands.
Nanne K H de BoerDepartment of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
Chris J J MulderDepartment of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
Luc J J DerijksDepartment of Clinical Pharmacy and Pharmacology, Máxima Medical Center, Veldhoven, The Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsShunting (hypermethylating) thiopurine metabolism, characterized by excessive 6-MMPR production and (sub)therapeutic 6-TGN levels, poses a significant challenge in the treatment of inflammatory bowel disease (IBD). This study evaluates the metabolic outcomes of switching to low-dose thiopurine with allopurinol (LDTA) or thioguanine (TG) in IBD patients with shunting metabolism.

methodsThis retrospective study analysed demographic data, thiopurine metabolite profiles, and adverse event rates in shunting IBD patients before and after switching to LDTA or TG therapy. Metabolite variability was assessed by examining alterations in 6-MMPR and 6-TGN levels and their correlation before and after therapy switch.

resultsBoth therapies significantly reduced toxic 6-MMPR levels, with 100% of patients achieving non-toxic levels (6-MMPR-level below 7000 pmol/8 × 10E8 RBC) post-therapy. For TG, 93% of patients attained non-toxic 6-TGN levels (6-TGN < 1000 pmol/8 × 10E8 RBC). In contrast, LDTA showed greater variability in 6-TGN outcomes, with 50% of patients reaching therapeutic levels, 31% remaining subtherapeutic, and 19% within toxic range. The slope for LDTA was significantly positive (1.044, R

conclusionsSwitching to LDTA or TG therapy in shunting IBD patients resulted in favourable alterations in thiopurine metabolism. However, LDTA appears to have a slightly less favourable metabolite profile, with some residual 6-MMPR formation and fewer patients achieving normal 6-TGN levels compared to TG. Given the challenges associated with achieving optimal thiopurine metabolite levels with LDTA and the need for closer monitoring of 6-TGN levels, TG appears a more suitable option for thiopurine shunting IBD patients.

Indexed as

AllopurinolAzathioprineInflammatory Bowel DiseasesMercaptopurineThioguanineAdultAgedDrug SubstitutionFemaleGuanine NucleotidesHumansMaleMethyltransferasesMiddle AgedRetrospective StudiesThioinosine6-methylthiopurine ribonucleoside-5'-phosphate6-thioguanylic acidAllopurinolAzathioprineGuanine NucleotidesMercaptopurineMethyltransferasesThioguanineThioinosineThionucleotidesallopurinolhypermethylationinflammatory bowel diseasethioguaninethiopurinesthiopurine shunting

Identifiers

PMID40421668
PMCPMC12464642

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