The Genetic Key to Safer Pediatric Immunosuppression
The Clinical Pharmacogenetics Implementation Consortium (CPIC) has released a critical 2025 update to its guideline for thiopurine dosing. These immunosuppressant drugs, including mercaptopurine, thioguanine, and azathioprine, are used to treat conditions like childhood leukemia and autoimmune disorders. The guideline provides specific recommendations for adjusting starting doses based on a patient’s genetic profile for the TPMT and NUDT15 enzymes. Individuals with certain genetic variants that reduce or eliminate enzyme activity are at a significantly higher risk of severe, potentially life-threatening myelosuppression when given standard doses. This update consolidates the latest evidence to help clinicians personalize treatment from the outset, minimizing adverse drug reactions.
Why it might matter to you: For pediatricians managing conditions like acute lymphoblastic leukemia or inflammatory bowel disease, this guideline is a direct tool for enhancing patient safety. Implementing pre-treatment genetic testing for TPMT and NUDT15 can prevent severe toxicity, reduce hospitalizations, and improve treatment adherence. It represents a concrete step toward precision medicine in pediatric pharmacology, where optimizing drug efficacy while avoiding harm is paramount.
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