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Rheumatology Advance Access published online on January 25, 2007
Rheumatology, doi:10.1093/rheumatology/kel427
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© The Author 2007. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Editorial

TPMT testing in rheumatology: any better than routine monitoring?

K. Payne1,2, W. Newman2,5, E. Fargher1,2, K. Tricker1,2, I. N. Bruce3,6 and W. E. R. Ollier4

1Nowgen, The North West Genetics Knowledge Park, 2Academic Unit of Medical Genetics, 3arc Epidemiology Unit and, 4Centre for Integrated Genomic Medical Research, The University of Manchester, 5Department of Medical Genetics and 6Rheumatism Research Centre, Central Manchester and Manchester Childrens’ University Hospitals NHS Trust, UK

Correspondence to: Dr Katherine Payne. E-mail: Katherine.payne@manchester.ac.uk

The first 150 words of the full text of this article appear below.

Azathioprine has been available as an immunosuppressive agent for over 40 yrs and is used widely in the management of rheumatological and other diseases [1]. In 2004, nearly 0.6 million prescriptions for azathioprine were dispensed in the community in England [2]. Azathioprine is an effective drug but there are concerns about the development of major adverse drug reactions. The past decade has seen a significant change in azathioprine prescribing practice in the UK following the introduction of thiopurine methyltransferase (TPMT) enzyme testing. Azathioprine dose selection based on TPMT enzyme testing to minimize the risk of neutropenia, offers the prospect of safer, more effective treatment.

Azathioprine is metabolized to its active metabolite by a series of enzyme steps, including TPMT. TPMT enzyme activity is highly variable: 90% of individuals have high/normal activity, 10% have intermediate activity and 0.3% low/absent activity [3]. The TPMT gene variant . . . [Full Text of this Article]


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