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

Authors

  • Xavier Roblin MD,

    1. Department of Hepato-Gastroenterology, University Hospital of Saint-Etienne, Saint-Etienne, France
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    • Roblin, Oussalah, Sparrow, and Peyrin-Biroulet contributed equally to the article.

  • Abderrahim Oussalah MD,

    1. Inserm U954, Henri Poincaré University Nancy 1, and Department of Hepato-Gastroenterology, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
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    • Roblin, Oussalah, Sparrow, and Peyrin-Biroulet contributed equally to the article.

  • Jean-Baptiste Chevaux MD,

    1. Inserm U954, Henri Poincaré University Nancy 1, and Department of Hepato-Gastroenterology, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
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  • Miles Sparrow MD,

    1. Department of Gastroenterology, the Alfred Hospital, Melbourne, Australia
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    • Roblin, Oussalah, Sparrow, and Peyrin-Biroulet contributed equally to the article.

  • Laurent Peyrin-Biroulet MD, PhD

    Corresponding author
    1. Inserm U954, Henri Poincaré University Nancy 1, and Department of Hepato-Gastroenterology, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
    • Department of Gastroenterology, University Hospital of Nancy, Allée du Morvan, 54 511 Vandœuvre-lès-Nancy, France
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    • Roblin, Oussalah, Sparrow, and Peyrin-Biroulet contributed equally to the article.


Abstract

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. (Inflamm Bowel Dis 2011)

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