Thiopurine metabolite levels in patients with atopic dermatitis and/or chronic hand/foot eczema treated with azathioprine
Background: Azathioprine is frequently used in severe eczema. It is converted in the liver into active metabolites, including 6-thioguanine nucleotide (6-TGN) and methylated 6-methylmercaptopurine (6-MMP). In the past, the therapeutic potential of azathioprine may have not been fully utilized. Recen...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2018-05-01
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| Series: | Journal of Dermatological Treatment |
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| Online Access: | http://dx.doi.org/10.1080/09546634.2017.1373738 |
| _version_ | 1797683720224768000 |
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| author | F. M. Garritsen J. van der Schaft C. A. F. Bruijnzeel-Koomen R. H. van Schaik M. de Graaf M. P. H. van den Broek M. S. de Bruin-Weller |
| author_facet | F. M. Garritsen J. van der Schaft C. A. F. Bruijnzeel-Koomen R. H. van Schaik M. de Graaf M. P. H. van den Broek M. S. de Bruin-Weller |
| author_sort | F. M. Garritsen |
| collection | DOAJ |
| description | Background: Azathioprine is frequently used in severe eczema. It is converted in the liver into active metabolites, including 6-thioguanine nucleotide (6-TGN) and methylated 6-methylmercaptopurine (6-MMP). In the past, the therapeutic potential of azathioprine may have not been fully utilized. Recent investigations on inflammatory bowel disease have led to a better understanding of azathioprine metabolism and optimizing treatment. Objective: To investigate whether measuring thiopurine metabolites in circulation can improve the effectiveness and safety of azathioprine treatment in patients with atopic dermatitis and/or chronic hand/foot eczema. Methods: Azathioprine metabolite levels were measured in eczema patients during maintenance treatment (Part I) and dose escalation (Part II). Clinical effectiveness, hepatotoxicity, and bone marrow suppression were analyzed and TPMT genotype was assessed. Results: A wide variation in metabolite levels in all dose groups was observed. In Part I (32 patients), there were no significant differences in 6-TGN levels between clinical responders and non-responders (p = .806). No hepatoxicity or myelotoxicity was observed. In Part II, all 6-TGN and 6-MMP levels increased during dose escalation. Hypermethylation was observed in 2/8 patients. Conclusion: For individual eczema patients treated with azathioprine, routinely measuring 6-TGN and 6-MMP can be helpful in optimizing azathioprine dose, improving clinical effectiveness, and preventing side effects. |
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| issn | 0954-6634 1471-1753 |
| language | English |
| last_indexed | 2024-03-12T00:18:51Z |
| publishDate | 2018-05-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Journal of Dermatological Treatment |
| spelling | doaj.art-09c8a1ff5ef24db4b2e9a78363c3c3012023-09-15T14:08:31ZengTaylor & Francis GroupJournal of Dermatological Treatment0954-66341471-17532018-05-0129437538210.1080/09546634.2017.13737381373738Thiopurine metabolite levels in patients with atopic dermatitis and/or chronic hand/foot eczema treated with azathioprineF. M. Garritsen0J. van der Schaft1C. A. F. Bruijnzeel-Koomen2R. H. van Schaik3M. de Graaf4M. P. H. van den Broek5M. S. de Bruin-Weller6University Medical Center UtrechtUniversity Medical Center UtrechtUniversity Medical Center UtrechtErasmus University Medical Center RotterdamUniversity Medical Center UtrechtUniversity Medical Center UtrechtUniversity Medical Center UtrechtBackground: Azathioprine is frequently used in severe eczema. It is converted in the liver into active metabolites, including 6-thioguanine nucleotide (6-TGN) and methylated 6-methylmercaptopurine (6-MMP). In the past, the therapeutic potential of azathioprine may have not been fully utilized. Recent investigations on inflammatory bowel disease have led to a better understanding of azathioprine metabolism and optimizing treatment. Objective: To investigate whether measuring thiopurine metabolites in circulation can improve the effectiveness and safety of azathioprine treatment in patients with atopic dermatitis and/or chronic hand/foot eczema. Methods: Azathioprine metabolite levels were measured in eczema patients during maintenance treatment (Part I) and dose escalation (Part II). Clinical effectiveness, hepatotoxicity, and bone marrow suppression were analyzed and TPMT genotype was assessed. Results: A wide variation in metabolite levels in all dose groups was observed. In Part I (32 patients), there were no significant differences in 6-TGN levels between clinical responders and non-responders (p = .806). No hepatoxicity or myelotoxicity was observed. In Part II, all 6-TGN and 6-MMP levels increased during dose escalation. Hypermethylation was observed in 2/8 patients. Conclusion: For individual eczema patients treated with azathioprine, routinely measuring 6-TGN and 6-MMP can be helpful in optimizing azathioprine dose, improving clinical effectiveness, and preventing side effects.http://dx.doi.org/10.1080/09546634.2017.1373738atopic dermatitisazathioprinemetabolitestherapeutic drug monitoring |
| spellingShingle | F. M. Garritsen J. van der Schaft C. A. F. Bruijnzeel-Koomen R. H. van Schaik M. de Graaf M. P. H. van den Broek M. S. de Bruin-Weller Thiopurine metabolite levels in patients with atopic dermatitis and/or chronic hand/foot eczema treated with azathioprine Journal of Dermatological Treatment atopic dermatitis azathioprine metabolites therapeutic drug monitoring |
| title | Thiopurine metabolite levels in patients with atopic dermatitis and/or chronic hand/foot eczema treated with azathioprine |
| title_full | Thiopurine metabolite levels in patients with atopic dermatitis and/or chronic hand/foot eczema treated with azathioprine |
| title_fullStr | Thiopurine metabolite levels in patients with atopic dermatitis and/or chronic hand/foot eczema treated with azathioprine |
| title_full_unstemmed | Thiopurine metabolite levels in patients with atopic dermatitis and/or chronic hand/foot eczema treated with azathioprine |
| title_short | Thiopurine metabolite levels in patients with atopic dermatitis and/or chronic hand/foot eczema treated with azathioprine |
| title_sort | thiopurine metabolite levels in patients with atopic dermatitis and or chronic hand foot eczema treated with azathioprine |
| topic | atopic dermatitis azathioprine metabolites therapeutic drug monitoring |
| url | http://dx.doi.org/10.1080/09546634.2017.1373738 |
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