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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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