What are the American Gastroenterological Association (AGA) recommendations for the use of 6-mercaptopurine (6-MP) and azathioprine (AZA) in the treatment of inflammatory bowel disease (IBD)?

Updated: Apr 10, 2020
  • Author: William A Rowe, MD; Chief Editor: BS Anand, MD  more...
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The American Gastroenterological Association (AGA), in accordance with the US Food and Drug Administration (FDA), recommends that patients undergo assessment of the thiopurine methyltransferase (TPMT) genotype or phenotype before starting therapy with AZA or 6-MP. [60] Individuals who have low enzyme activity or are homozygous deficient in the TPMT mutation are at risk of very severe leukopenia, with potential septic complications, and may not be good candidates for therapy with these drugs. [60]

About 11% of individuals with heterozygous TPMT activity respond well to therapy but are prone to myelotoxicity, although this can be minimized with the use of lower doses. These patients, as well as those with wild-type TPMT activity, require monitoring for complications. [60]

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