6-mercaptopurine therapy

Carmen Cuffari

Research output: Chapter in Book/Report/Conference proceedingChapter


6-Mercaptopurine (6-MP) and its pro-drug azathioprine have proven efficacy in the maintenance of disease remission in children with steroid-dependent Crohn's disease. However, not all patients respond effectively to therapy, while others are predisposed to drug-induced toxicity; thereby, suggesting that inherent differences in anti-metabolite metabolism may influence clinical responsiveness to therapy. Although genomic (TPMT) and drug metabolite monitoring have been available for greater than a decade, there is more debate than consensus on their application in clinical practice, primarily due to the lack of controlled clinical trials.Nevertheless, patients with a homozygous recessive TPMT genotype should not be considered candidates for anti-metabolite therapy. Physicians treating patients with a heterozygote genotype should consider a more moderate dosing strategy, while carefully monitoring for potential antimetabolite-induced cytotoxicity. In these patients, 6-MP-metabolite testing may help clinicians monitor immunosuppression and decrease the risk of toxicity. Future prospective clinical trials are necessary in order to develop a therapeutic window of clinical efficacy and toxicity based on the measurement of these drug metabolites.

Original languageEnglish (US)
Title of host publicationPediatric Inflammatory Bowel Disease, Second Edition
PublisherSpringer New York
Number of pages7
ISBN (Electronic)9781461450610
ISBN (Print)9781461450603
StatePublished - Jan 1 2013

ASJC Scopus subject areas

  • General Medicine


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