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Dosing azathioprine in thiopurine S-methyltransferase deficient inflammatory bowel disease patients
  1. L J J Derijks1,
  2. R B van Helden2,
  3. D W Hommes2,
  4. P C Stokkers3,4
  1. 1
    Department of Clinical Pharmacy, Máxima Medical Center, Veldhoven, The Netherlands
  2. 2
    Department of Gastroenterology & Hepatology, Leiden University Medical Center, Leiden, The Netherlands
  3. 3 Department of Gastroenterology & Hepatology, Academic Medical Center, Amsterdam, The Netherlands
  1. Dr Luc J J Derijks, Department of Clinical Pharmacy, Máxima Medical Center, PO Box 7777, 5500 MB Veldhoven, The Netherlands; l.derijks{at}mmc.nl

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With great interest we read the article by Kaskas et al (Gut 2003;52:140–2) about safe treatment of thiopurine S-methyltransferase (TPMT) deficient Crohn’s disease patients with azathioprine (AZA). In this paper it is illustrated that TPMT-deficient patients can be successfully treated with very low doses of AZA (∼10% of standard initial dose).

Unfortunately, this is not the case for all homozygous mutant TPMT allele carriers. This is demonstrated by the case report of an exceptional thiopurine S-methyltransferase deficient patient with inflammatory bowel disease who we identified recently. A 19-year-old man with ulcerative colitis who was attending the outpatient clinic was treated with …

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