Updated genetic roadmap for safer thiopurine dosing in autoimmune care
The Clinical Pharmacogenetics Implementation Consortium (CPIC) has released its 2025 update on thiopurine dosing, solidifying the role of genetic testing for TPMT and NUDT15 enzymes. This guideline provides specific recommendations for adjusting starting doses of drugs like azathioprine and mercaptopurine based on a patient’s genotype to mitigate the risk of severe adverse effects, including life-threatening myelosuppression. The update emphasizes that genetic variants affecting these drug-metabolizing pathways are present across all global populations, though their frequency varies, necessitating a personalized medicine approach to optimize therapeutic safety and efficacy in conditions treated with these immunosuppressants.
Why it might matter to you: For rheumatologists managing autoimmune diseases like lupus or inflammatory arthritis with thiopurines, this updated guideline is a critical tool for precision medicine. It directly informs clinical decisions to prevent treatment-related toxicity, a major concern in long-term immunosuppressive therapy. Implementing this pharmacogenetic testing can enhance patient safety, improve adherence by reducing adverse events, and represents a concrete step toward more personalized and effective disease-modifying antirheumatic drug (DMARD) strategies.
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