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Thiopurine methyltransferase screening before azathioprine therapy
  1. V Gauba1,
  2. M Saldanha2,
  3. C Vize2,
  4. G M Saleh3
  1. 1St James’ University Hospital, Leeds, UK
  2. 2Hull and East Yorkshire Eye Hospital, UK
  3. 3Royal Surrey County Hospital, UK
  1. Correspondence to: Vinod Gauba 33 Alder Hill Avenue, Leeds LS6 4JQ, UK; vgauba{at}

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Azathioprine is used to treat various inflammatory eye conditions such as uveitis and dysthyroid orbitopathy. Despite good overall clinical response rates, particularly when used as steroid sparing agent, adverse effects such as severe myelosuppression can lead to early withdrawal in approximately a quarter of patients.1,2

Thiopurine methyltransferase (TPMT) is a cytosolic enzyme that metabolises azathioprine in vivo. The risk of azathioprine induced myelosuppression may be predicted by detecting patients with intermediate or low TPMT activity. The human TPMT gene exhibits genetic polymorphism that is evident in all populations studied to date.3 Population studies have shown 89% of white people have high TPMT activity, 11% have intermediate, and 0.3% have …

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  • Competing interests: none.