Risk factors for thiopurine‐induced myelosuppression and infections in inflammatory bowel disease patients with a normal TPMT genotype
Summary Background Leucopenia is a common side effect in patients treated with thiopurines. Variants in the thiopurine S‐methyltransferase (TPMT) gene are the best‐known risk factor, but only explain up to 25% of leucopenia cases. Aim To identify the clinical risk factors for thiopurine‐induced leuc...
Gespeichert in:
| Veröffentlicht in: | Alimentary pharmacology & therapeutics 2017-11, Vol.46 (10), p.953-963 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 963 |
|---|---|
| container_issue | 10 |
| container_start_page | 953 |
| container_title | Alimentary pharmacology & therapeutics |
| container_volume | 46 |
| creator | Broekman, M. M. T. J. Coenen, M. J. H. Wanten, G. J. van Marrewijk, C. J. Klungel, O. H. Verbeek, A. L. M. Hooymans, P. M. Guchelaar, H.‐J. Scheffer, H. Derijks, L. J. J. Wong, D. R. Jong, D. J. |
| description | Summary
Background
Leucopenia is a common side effect in patients treated with thiopurines. Variants in the thiopurine S‐methyltransferase (TPMT) gene are the best‐known risk factor, but only explain up to 25% of leucopenia cases.
Aim
To identify the clinical risk factors for thiopurine‐induced leucopenia in patients without a common TPMT variant, and explore if these patients are at increased risk for infections.
Methods
Post hoc analysis of the Thiopurine response Optimisation by Pharmacogenetic testing in Inflammatory bowel disease Clinics (TOPIC) trial. For this analysis, patients without a variant in TPMT (*2, *3A or*3C) were included. Uni‐ and multivariate Cox‐proportional hazard models were used to identify risk factors for leucopenia and infections. Leucopenia was defined as a white blood cell (WBC) count |
| doi_str_mv | 10.1111/apt.14323 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5698717</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1953037274</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4083-85ce90474b50d26674898cd36f9400fe67593792a5f7f1fa77aafca634e8f6e23</originalsourceid><addsrcrecordid>eNp1kctu1DAUhi1ERYfCghdAllixSOtb7GSDVFXcpFat0LC2PM5xxyWxg50wyo4lS56RJ8FlSlUWeGMf-dN3fulH6AUlx7ScEzNOx1Rwxh-hFeWyrhjh8jFaESbbijWUH6KnOd8QQqQi7Ak6ZE1LhRByhX588vkLdsZOMWXsYsLT1sdxTj7Ar-8_fehmCx0eFuhjnscxQc4-BmxCh31wYKcy5fK8nXozDKaIFryJO-hx5zOYDHg0k4cwZbzz0xYbHGIaTI_XVxdrfA0hTssIz9CBM32G53f3Efr87u367EN1fvn-49npeWUFaXjV1BZaIpTY1KRjUirRtI3tuHStIMSBVHXLVctM7ZSjzihljLNGcgGNk8D4EXqz947zZoDOllzJ9HpMfjBp0dF4_e9P8Ft9Hb_pWraNoqoIXt0JUvw6Q570TZxTKJk1bWtOuGJKFOr1nrIp5pzA3W-gRN-Wpktp-k9phX35MNI9-belApzsgZ3vYfm_SZ9erffK39tKphA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1953037274</pqid></control><display><type>article</type><title>Risk factors for thiopurine‐induced myelosuppression and infections in inflammatory bowel disease patients with a normal TPMT genotype</title><source>Wiley Free Content</source><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Broekman, M. M. T. J. ; Coenen, M. J. H. ; Wanten, G. J. ; van Marrewijk, C. J. ; Klungel, O. H. ; Verbeek, A. L. M. ; Hooymans, P. M. ; Guchelaar, H.‐J. ; Scheffer, H. ; Derijks, L. J. J. ; Wong, D. R. ; Jong, D. J.</creator><creatorcontrib>Broekman, M. M. T. J. ; Coenen, M. J. H. ; Wanten, G. J. ; van Marrewijk, C. J. ; Klungel, O. H. ; Verbeek, A. L. M. ; Hooymans, P. M. ; Guchelaar, H.‐J. ; Scheffer, H. ; Derijks, L. J. J. ; Wong, D. R. ; Jong, D. J.</creatorcontrib><description>Summary
Background
Leucopenia is a common side effect in patients treated with thiopurines. Variants in the thiopurine S‐methyltransferase (TPMT) gene are the best‐known risk factor, but only explain up to 25% of leucopenia cases.
Aim
To identify the clinical risk factors for thiopurine‐induced leucopenia in patients without a common TPMT variant, and explore if these patients are at increased risk for infections.
Methods
Post hoc analysis of the Thiopurine response Optimisation by Pharmacogenetic testing in Inflammatory bowel disease Clinics (TOPIC) trial. For this analysis, patients without a variant in TPMT (*2, *3A or*3C) were included. Uni‐ and multivariate Cox‐proportional hazard models were used to identify risk factors for leucopenia and infections. Leucopenia was defined as a white blood cell (WBC) count <3.0 × 109/L and infections were classified according to the Common Terminology Criteria for Adverse Events.
Results
Sixty hundred and ninety‐five patients (90.6%) included in the TOPIC‐trial had no variant in TPMT, of which 45 (6.5%) developed leucopenia. Median time to leucopenia was 56 (29‐112) days. Multivariate analysis showed that use of mercaptopurine compared to azathioprine was associated with leucopenia (hazard ratio [HR] 2.61 [95% CIs, 1.39‐4.88; P < .01]) and a higher baseline WBC count was protective (HR 0.80 [95% CIs, 0.71‐0.89; P < .01]). Risk factors for infections were older age (per 10 year; HR 2.07 [95% CIs, 1.18‐3.63; P = .01]) and concomitant use of biologic drugs (HR 2.15 [95% CIs, 1.14‐4.07; P = .02]).
Conclusions
Low baseline WBC count and mercaptopurine, due to a relatively higher dose, were risk factors for thiopurine‐induced leucopenia in patients without a TPMT variant.
Linked ContentThis article is linked to Willington and Gearry and Broekman et al papers. To view these articles visit https://doi.org/10.1111/apt.14370 and https://doi.org/10.1111/apt.14395.</description><identifier>ISSN: 0269-2813</identifier><identifier>EISSN: 1365-2036</identifier><identifier>DOI: 10.1111/apt.14323</identifier><identifier>PMID: 28914446</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>6-Mercaptopurine ; Adult ; Azathioprine ; Azathioprine - adverse effects ; Azathioprine - therapeutic use ; Blood cells ; Case-Control Studies ; Female ; Genotype ; Health risk assessment ; Health risks ; Humans ; Infections ; Inflammatory bowel disease ; Inflammatory bowel diseases ; Inflammatory Bowel Diseases - drug therapy ; Intestine ; Leukopenia ; Leukopenia - chemically induced ; Male ; Mercaptopurine - administration & dosage ; Mercaptopurine - adverse effects ; Methyltransferase ; Methyltransferases - genetics ; Middle Aged ; Multivariate analysis ; Myelosuppression ; Original ; Polymorphism, Genetic ; Risk Factors ; Side effects ; Thiopurine Myelosuppression and Infections in IBD ; Thiopurine S-methyltransferase</subject><ispartof>Alimentary pharmacology & therapeutics, 2017-11, Vol.46 (10), p.953-963</ispartof><rights>2017 The Authors. published by John Wiley & Sons Ltd.</rights><rights>2017 The Authors. Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.</rights><rights>Copyright © 2017 John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4083-85ce90474b50d26674898cd36f9400fe67593792a5f7f1fa77aafca634e8f6e23</citedby><cites>FETCH-LOGICAL-c4083-85ce90474b50d26674898cd36f9400fe67593792a5f7f1fa77aafca634e8f6e23</cites><orcidid>0000-0002-6038-9295 ; 0000-0002-3835-2613 ; 0000-0001-5523-2771</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fapt.14323$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fapt.14323$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,1411,1427,27901,27902,45550,45551,46384,46808</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28914446$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Broekman, M. M. T. J.</creatorcontrib><creatorcontrib>Coenen, M. J. H.</creatorcontrib><creatorcontrib>Wanten, G. J.</creatorcontrib><creatorcontrib>van Marrewijk, C. J.</creatorcontrib><creatorcontrib>Klungel, O. H.</creatorcontrib><creatorcontrib>Verbeek, A. L. M.</creatorcontrib><creatorcontrib>Hooymans, P. M.</creatorcontrib><creatorcontrib>Guchelaar, H.‐J.</creatorcontrib><creatorcontrib>Scheffer, H.</creatorcontrib><creatorcontrib>Derijks, L. J. J.</creatorcontrib><creatorcontrib>Wong, D. R.</creatorcontrib><creatorcontrib>Jong, D. J.</creatorcontrib><title>Risk factors for thiopurine‐induced myelosuppression and infections in inflammatory bowel disease patients with a normal TPMT genotype</title><title>Alimentary pharmacology & therapeutics</title><addtitle>Aliment Pharmacol Ther</addtitle><description>Summary
Background
Leucopenia is a common side effect in patients treated with thiopurines. Variants in the thiopurine S‐methyltransferase (TPMT) gene are the best‐known risk factor, but only explain up to 25% of leucopenia cases.
Aim
To identify the clinical risk factors for thiopurine‐induced leucopenia in patients without a common TPMT variant, and explore if these patients are at increased risk for infections.
Methods
Post hoc analysis of the Thiopurine response Optimisation by Pharmacogenetic testing in Inflammatory bowel disease Clinics (TOPIC) trial. For this analysis, patients without a variant in TPMT (*2, *3A or*3C) were included. Uni‐ and multivariate Cox‐proportional hazard models were used to identify risk factors for leucopenia and infections. Leucopenia was defined as a white blood cell (WBC) count <3.0 × 109/L and infections were classified according to the Common Terminology Criteria for Adverse Events.
Results
Sixty hundred and ninety‐five patients (90.6%) included in the TOPIC‐trial had no variant in TPMT, of which 45 (6.5%) developed leucopenia. Median time to leucopenia was 56 (29‐112) days. Multivariate analysis showed that use of mercaptopurine compared to azathioprine was associated with leucopenia (hazard ratio [HR] 2.61 [95% CIs, 1.39‐4.88; P < .01]) and a higher baseline WBC count was protective (HR 0.80 [95% CIs, 0.71‐0.89; P < .01]). Risk factors for infections were older age (per 10 year; HR 2.07 [95% CIs, 1.18‐3.63; P = .01]) and concomitant use of biologic drugs (HR 2.15 [95% CIs, 1.14‐4.07; P = .02]).
Conclusions
Low baseline WBC count and mercaptopurine, due to a relatively higher dose, were risk factors for thiopurine‐induced leucopenia in patients without a TPMT variant.
Linked ContentThis article is linked to Willington and Gearry and Broekman et al papers. To view these articles visit https://doi.org/10.1111/apt.14370 and https://doi.org/10.1111/apt.14395.</description><subject>6-Mercaptopurine</subject><subject>Adult</subject><subject>Azathioprine</subject><subject>Azathioprine - adverse effects</subject><subject>Azathioprine - therapeutic use</subject><subject>Blood cells</subject><subject>Case-Control Studies</subject><subject>Female</subject><subject>Genotype</subject><subject>Health risk assessment</subject><subject>Health risks</subject><subject>Humans</subject><subject>Infections</subject><subject>Inflammatory bowel disease</subject><subject>Inflammatory bowel diseases</subject><subject>Inflammatory Bowel Diseases - drug therapy</subject><subject>Intestine</subject><subject>Leukopenia</subject><subject>Leukopenia - chemically induced</subject><subject>Male</subject><subject>Mercaptopurine - administration & dosage</subject><subject>Mercaptopurine - adverse effects</subject><subject>Methyltransferase</subject><subject>Methyltransferases - genetics</subject><subject>Middle Aged</subject><subject>Multivariate analysis</subject><subject>Myelosuppression</subject><subject>Original</subject><subject>Polymorphism, Genetic</subject><subject>Risk Factors</subject><subject>Side effects</subject><subject>Thiopurine Myelosuppression and Infections in IBD</subject><subject>Thiopurine S-methyltransferase</subject><issn>0269-2813</issn><issn>1365-2036</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>EIF</sourceid><recordid>eNp1kctu1DAUhi1ERYfCghdAllixSOtb7GSDVFXcpFat0LC2PM5xxyWxg50wyo4lS56RJ8FlSlUWeGMf-dN3fulH6AUlx7ScEzNOx1Rwxh-hFeWyrhjh8jFaESbbijWUH6KnOd8QQqQi7Ak6ZE1LhRByhX588vkLdsZOMWXsYsLT1sdxTj7Ar-8_fehmCx0eFuhjnscxQc4-BmxCh31wYKcy5fK8nXozDKaIFryJO-hx5zOYDHg0k4cwZbzz0xYbHGIaTI_XVxdrfA0hTssIz9CBM32G53f3Efr87u367EN1fvn-49npeWUFaXjV1BZaIpTY1KRjUirRtI3tuHStIMSBVHXLVctM7ZSjzihljLNGcgGNk8D4EXqz947zZoDOllzJ9HpMfjBp0dF4_e9P8Ft9Hb_pWraNoqoIXt0JUvw6Q570TZxTKJk1bWtOuGJKFOr1nrIp5pzA3W-gRN-Wpktp-k9phX35MNI9-belApzsgZ3vYfm_SZ9erffK39tKphA</recordid><startdate>201711</startdate><enddate>201711</enddate><creator>Broekman, M. M. T. J.</creator><creator>Coenen, M. J. H.</creator><creator>Wanten, G. J.</creator><creator>van Marrewijk, C. J.</creator><creator>Klungel, O. H.</creator><creator>Verbeek, A. L. M.</creator><creator>Hooymans, P. M.</creator><creator>Guchelaar, H.‐J.</creator><creator>Scheffer, H.</creator><creator>Derijks, L. J. J.</creator><creator>Wong, D. R.</creator><creator>Jong, D. J.</creator><general>Wiley Subscription Services, Inc</general><general>John Wiley and Sons Inc</general><scope>24P</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7U9</scope><scope>H94</scope><scope>M7N</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-6038-9295</orcidid><orcidid>https://orcid.org/0000-0002-3835-2613</orcidid><orcidid>https://orcid.org/0000-0001-5523-2771</orcidid></search><sort><creationdate>201711</creationdate><title>Risk factors for thiopurine‐induced myelosuppression and infections in inflammatory bowel disease patients with a normal TPMT genotype</title><author>Broekman, M. M. T. J. ; Coenen, M. J. H. ; Wanten, G. J. ; van Marrewijk, C. J. ; Klungel, O. H. ; Verbeek, A. L. M. ; Hooymans, P. M. ; Guchelaar, H.‐J. ; Scheffer, H. ; Derijks, L. J. J. ; Wong, D. R. ; Jong, D. J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4083-85ce90474b50d26674898cd36f9400fe67593792a5f7f1fa77aafca634e8f6e23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>6-Mercaptopurine</topic><topic>Adult</topic><topic>Azathioprine</topic><topic>Azathioprine - adverse effects</topic><topic>Azathioprine - therapeutic use</topic><topic>Blood cells</topic><topic>Case-Control Studies</topic><topic>Female</topic><topic>Genotype</topic><topic>Health risk assessment</topic><topic>Health risks</topic><topic>Humans</topic><topic>Infections</topic><topic>Inflammatory bowel disease</topic><topic>Inflammatory bowel diseases</topic><topic>Inflammatory Bowel Diseases - drug therapy</topic><topic>Intestine</topic><topic>Leukopenia</topic><topic>Leukopenia - chemically induced</topic><topic>Male</topic><topic>Mercaptopurine - administration & dosage</topic><topic>Mercaptopurine - adverse effects</topic><topic>Methyltransferase</topic><topic>Methyltransferases - genetics</topic><topic>Middle Aged</topic><topic>Multivariate analysis</topic><topic>Myelosuppression</topic><topic>Original</topic><topic>Polymorphism, Genetic</topic><topic>Risk Factors</topic><topic>Side effects</topic><topic>Thiopurine Myelosuppression and Infections in IBD</topic><topic>Thiopurine S-methyltransferase</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Broekman, M. M. T. J.</creatorcontrib><creatorcontrib>Coenen, M. J. H.</creatorcontrib><creatorcontrib>Wanten, G. J.</creatorcontrib><creatorcontrib>van Marrewijk, C. J.</creatorcontrib><creatorcontrib>Klungel, O. H.</creatorcontrib><creatorcontrib>Verbeek, A. L. M.</creatorcontrib><creatorcontrib>Hooymans, P. M.</creatorcontrib><creatorcontrib>Guchelaar, H.‐J.</creatorcontrib><creatorcontrib>Scheffer, H.</creatorcontrib><creatorcontrib>Derijks, L. J. J.</creatorcontrib><creatorcontrib>Wong, D. R.</creatorcontrib><creatorcontrib>Jong, D. J.</creatorcontrib><collection>Wiley-Blackwell Open Access Titles</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Alimentary pharmacology & therapeutics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Broekman, M. M. T. J.</au><au>Coenen, M. J. H.</au><au>Wanten, G. J.</au><au>van Marrewijk, C. J.</au><au>Klungel, O. H.</au><au>Verbeek, A. L. M.</au><au>Hooymans, P. M.</au><au>Guchelaar, H.‐J.</au><au>Scheffer, H.</au><au>Derijks, L. J. J.</au><au>Wong, D. R.</au><au>Jong, D. J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk factors for thiopurine‐induced myelosuppression and infections in inflammatory bowel disease patients with a normal TPMT genotype</atitle><jtitle>Alimentary pharmacology & therapeutics</jtitle><addtitle>Aliment Pharmacol Ther</addtitle><date>2017-11</date><risdate>2017</risdate><volume>46</volume><issue>10</issue><spage>953</spage><epage>963</epage><pages>953-963</pages><issn>0269-2813</issn><eissn>1365-2036</eissn><abstract>Summary
Background
Leucopenia is a common side effect in patients treated with thiopurines. Variants in the thiopurine S‐methyltransferase (TPMT) gene are the best‐known risk factor, but only explain up to 25% of leucopenia cases.
Aim
To identify the clinical risk factors for thiopurine‐induced leucopenia in patients without a common TPMT variant, and explore if these patients are at increased risk for infections.
Methods
Post hoc analysis of the Thiopurine response Optimisation by Pharmacogenetic testing in Inflammatory bowel disease Clinics (TOPIC) trial. For this analysis, patients without a variant in TPMT (*2, *3A or*3C) were included. Uni‐ and multivariate Cox‐proportional hazard models were used to identify risk factors for leucopenia and infections. Leucopenia was defined as a white blood cell (WBC) count <3.0 × 109/L and infections were classified according to the Common Terminology Criteria for Adverse Events.
Results
Sixty hundred and ninety‐five patients (90.6%) included in the TOPIC‐trial had no variant in TPMT, of which 45 (6.5%) developed leucopenia. Median time to leucopenia was 56 (29‐112) days. Multivariate analysis showed that use of mercaptopurine compared to azathioprine was associated with leucopenia (hazard ratio [HR] 2.61 [95% CIs, 1.39‐4.88; P < .01]) and a higher baseline WBC count was protective (HR 0.80 [95% CIs, 0.71‐0.89; P < .01]). Risk factors for infections were older age (per 10 year; HR 2.07 [95% CIs, 1.18‐3.63; P = .01]) and concomitant use of biologic drugs (HR 2.15 [95% CIs, 1.14‐4.07; P = .02]).
Conclusions
Low baseline WBC count and mercaptopurine, due to a relatively higher dose, were risk factors for thiopurine‐induced leucopenia in patients without a TPMT variant.
Linked ContentThis article is linked to Willington and Gearry and Broekman et al papers. To view these articles visit https://doi.org/10.1111/apt.14370 and https://doi.org/10.1111/apt.14395.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>28914446</pmid><doi>10.1111/apt.14323</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-6038-9295</orcidid><orcidid>https://orcid.org/0000-0002-3835-2613</orcidid><orcidid>https://orcid.org/0000-0001-5523-2771</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0269-2813 |
| ispartof | Alimentary pharmacology & therapeutics, 2017-11, Vol.46 (10), p.953-963 |
| issn | 0269-2813 1365-2036 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5698717 |
| source | Wiley Free Content; MEDLINE; Wiley Online Library Journals Frontfile Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | 6-Mercaptopurine Adult Azathioprine Azathioprine - adverse effects Azathioprine - therapeutic use Blood cells Case-Control Studies Female Genotype Health risk assessment Health risks Humans Infections Inflammatory bowel disease Inflammatory bowel diseases Inflammatory Bowel Diseases - drug therapy Intestine Leukopenia Leukopenia - chemically induced Male Mercaptopurine - administration & dosage Mercaptopurine - adverse effects Methyltransferase Methyltransferases - genetics Middle Aged Multivariate analysis Myelosuppression Original Polymorphism, Genetic Risk Factors Side effects Thiopurine Myelosuppression and Infections in IBD Thiopurine S-methyltransferase |
| title | Risk factors for thiopurine‐induced myelosuppression and infections in inflammatory bowel disease patients with a normal TPMT genotype |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-15T01%3A34%3A28IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Risk%20factors%20for%20thiopurine%E2%80%90induced%20myelosuppression%20and%20infections%20in%20inflammatory%20bowel%20disease%20patients%20with%20a%20normal%20TPMT%20genotype&rft.jtitle=Alimentary%20pharmacology%20&%20therapeutics&rft.au=Broekman,%20M.%20M.%20T.%20J.&rft.date=2017-11&rft.volume=46&rft.issue=10&rft.spage=953&rft.epage=963&rft.pages=953-963&rft.issn=0269-2813&rft.eissn=1365-2036&rft_id=info:doi/10.1111/apt.14323&rft_dat=%3Cproquest_pubme%3E1953037274%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1953037274&rft_id=info:pmid/28914446&rfr_iscdi=true |