6-Mercaptopurine (6-MP) and its parent drug azathioprine (AZA) are well-known for their immunosuppressive and lymphocytotoxic properties. [1, 2] These anti-metabolite drugs have been shown to suppress disease activity in up to 70% of children with IBD; and among these patients, 50% will achieve a clinical response after 4 months of continuous therapy. [3, 4] Although the overall risk of 6-MP induced toxicity is low, [5, 6] not all patients achieve disease remission despite presumed therapeutic drug dosing; thereby suggesting that inherent differences in either drug metabolism  or immune modulation  may influence clinical responsiveness to therapy. Herein, we will review the use of AZA and 6-MP in the management of pediatric patients with IBD. Furthermore, the application of pharmacogenomic and 6-MP metabolite testing will also be discussed based on an analysis of the literature. Several recommendations will also be provided on applying this technology into clinical practice.
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