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Use of thiopurine testing in the management of inflammatory bowel diseases in clinical practice: A worldwide survey of experts

Roblin, Xavier MD1; Oussalah, Abderrahim MD2; Chevaux, Jean-Baptiste MD2; Sparrow, Miles MD3; Peyrin-Biroulet, Laurent MD, PhD2,*

doi: 10.1002/ibd.21662
Original Article

Background: We performed a worldwide survey to evaluate the extent to which gastroenterologists who are experts in the field of inflammatory bowel diseases (IBDs) are utilizing thiopurine metabolism in practice.

Methods: This was a Web-based cross-sectional survey consisting of 12 multiple-choice and open-ended questions.

Results: Between December 2009 and April 2010, 175 questionnaires were received. The proportion of practitioners with access and reimbursement for thiopurine S-methyltransferase (TPMT) genotype, TPMT phenotype, 6-thioguanine nucleotides (6-TGN) levels, and 6-methylmercaptopurine ribonucleotides (6-MMP) levels was 48%, 54%, 44%, and 35%, respectively. Before azathioprine initiation, TPMT genotype and phenotype were performed by only 30% and 43% of responders, respectively. In patients on thiopurine therapy, 6-TGN and 6-MMP levels were determined by 54% and 44% of responders, respectively. Only 27% of physicians always wait for TMPT activity/genotype results before initiating azathioprine and 81% do not routinely recheck metabolite levels after dose escalation or reduction. In cases of very high or low TPMT activity, 75% and 74% of practitioners take into account TMPT activity result, respectively. If access to all azathioprine metabolite measurements was available and if all these tests were reimbursed by public health insurance, 47% of responders would use these tests more often in their practice. The availability and reimbursement of TPMT status and azathioprine metabolites strongly influenced experts' attitudes.

Conclusions: Thiopurine testing is relatively underutilized by IBD gastroenterologists. The availability and reimbursement of TPMT status and azathioprine metabolites strongly influence the management of IBD patients treated with thiopurines.

1 Department of Hepato-Gastroenterology, University Hospital of Saint-Etienne, Saint-Etienne, France

2 Inserm U954, Henri Poincaré University Nancy 1, and Department of Hepato-Gastroenterology, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France

3 Department of Gastroenterology, the Alfred Hospital, Melbourne, Australia

*Reprints: Department of Gastroenterology, University Hospital of Nancy, Allée du Morvan, 54 511 Vandœuvre-lès-Nancy, France


Received 18 December 2010; Accepted 31 December 2010

Published online 23 February 2011 in Wiley Online Library (

Roblin, Oussalah, Sparrow, and Peyrin-Biroulet contributed equally to the article.

© Crohn's & Colitis Foundation of America, Inc.
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