Therapeutic Drug Monitoring and Pharmacogenomics of Thiopurines in Inflammatory Bowel Disease: International Guidelines Revisited.

TPMT/NUDT15 variability → variable thiopurine metabolism → combined TDM (6-TGN metabolites) + genotyping for individual optimization

This scoping review compares international guidelines on therapeutic drug monitoring (TDM) and pharmacogenomics of thiopurines in IBD. Important differences between guidelines (ECCO, AGA, BSG, CPIC) are identified, notably on 6-TGN metabolite thresholds, TPMT/NUDT15 genotyping indications, and the role of thioguanine. TDM + PGx integration is proposed as standard to personalize dosing and reduce hematologic and hepatic toxicities.

Synthesis written by Geno'X. For the full original abstract, please refer to the source publication.

Thiopurines remain widely prescribed in IBD despite well-documented severe toxicity risks, and TPMT/NUDT15 genotyping is CPIC level A. This comparative guidelines review is useful for harmonizing practices between centers — particularly in settings where TDM alone is practiced without systematic genotyping.

Clinical impact: 2/3 · Evidence strength: 2/3 · Novelty: 1/2 · Sample size: 1/1 · Publication status: 0/1 → Total: 6/10