Annotation of DPWG Guideline for azathioprine and TPMT

Summary

Select an alternative drug or reduce the initial dose of azathioprine for patients that are TPMT poor metabolizers and reduce initial dose for patients that are TPMT intermediate metabolizers.

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Alleles not present in the above pull-down menus have no recommendation.

Important information about alleles in DPWG guidelines.

Annotation

Read more about how PharmGKB curates DPWG guidelines using extra information provided by DPWG to enable the interactive genotype tool above.

May 2020 Update

The Royal Dutch Pharmacists Association - Pharmacogenetics Working Group has evaluated therapeutic dose recommendations for azathioprine based on TPMT genotype. They recommend reducing the initial dose for patients that are intermediate metabolizers and selecting an alternative drug or reducing the initial dose for patients that are poor metabolizers. They removed the sentence "The frequency of monitoring should be increased." from the previous recommendation.

Wording in table taken from the Dutch guidelines May 2020 update.

Read for more information about this recommendation. Read about gene information from DPWG

Preemptive genotyping

Excerpts from the DPWG risk analysis document for azathioprine and TPMT:

The Dutch Pharmacogenetics Working Group considers genotyping before starting azathioprine or 6-mercaptopurine to be essential for drug safety. Genotyping must be performed before drug therapy has been initiated to guide drug and dose selection.

Read more about how DPWG assigns their recommendations for preemptive genotyping.

August 2019 Update

The Royal Dutch Pharmacists Association - Pharmacogenetics Working Group has evaluated therapeutic dose recommendations for azathioprine based on TPMT genotype. They recommend reducing the initial dose for patients that are intermediate metabolizers and selecting an alternative drug or reducing the initial dose for patients that are poor metabolizers.

Wording in table taken from the Dutch guidelines August 2019 update.

November 2018 Update

The Royal Dutch Pharmacists Association - Pharmacogenetics Working Group has evaluated therapeutic dose recommendations for azathioprine based on TPMT genotype. They recommend reducing the initial dose for patients that are intermediate metabolizers and selecting an alternative drug or reducing the initial dose for patients that are poor metabolizers.

Wording in table taken from the Dutch guidelines November 2018 update.

2011 Guideline

The Royal Dutch Pharmacists Association - Pharmacogenetics Working Group has evaluated therapeutic dose recommendations for azathioprine based on TPMT genotype [Article:21412232]. They recommend selecting an alternative drug or reducing the initial dose for patients carrying inactive alleles.

  • *See Methods or [Article:18253145] for definition of "good quality."
  • S: statistically significant difference.

PharmGKB ID

PA166104934