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Assessment of Thiopurine Methyltransferase Activity in Patients Prescribed Azathioprine or Other Thiopurine-Based Drugs

Assessment of Thiopurine Methyltransferase Activity in Patients Prescribed Azathioprine or Other Thiopurine-Based Drugs

Evidence Reports/Technology Assessments - Agency for Healthcare Research and Quality (US)

Version: December 2010

Results

The PRISMA diagram in Figure 3 depicts the flow of retrieved records through the phases of screening and inclusion. Overall, 1783 records were identified by systematic searches of databases and seven, were nominated by the Technical Expert Panel and reviewers. A third level of content expert screening was employed to ensure that laboratory studies identified for key questions 1a, 1b and 1d did not include irrelevant records, as a result of relatively liberal screening at the two prior levels.

Discussion

This review was nominated by the American Association for Clinical Chemistry (AACC), and commissioned by the Agency for Healthcare Research and Quality (AHRQ), to examine testing for thiopurine methyltransferase (TPMT) enzymatic activity (phenotype), and allelic polymorphism determination (genotype) in chronic autoimmune disease, with an overall view potentially to optimize use of thiopurine medications. The objectives were to examine the analytical aspects of TPMT status determination (genotype or phenotype); and resultant change in patient management and clinical outcomes of thiopurine toxicity in light of pretreatment knowledge of TPMT status; and costs associated with TPMT testing, along with costs of adverse events arising from thiopurine toxicities. Inclusion of evidence to meet these objectives was restricted to chronic autoimmune disease populations.

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