Biomarkers for gastrointestinal adverse events related to thiopurine therapy

Thiopurines are immunomodulators used in the treatment of acute lymphoblastic leukemia and inflammatory bowel diseases. Adverse reactions to these agents are one of the main causes of treatment discontinuation or interruption. Myelosuppression is the most frequent adverse effect; however, approximately 5%-20% of patients develop gastrointestinal toxicity. The identification of biomarkers able to prevent and/or monitor these adverse reactions would be useful for clinicians for the proactive management of long-term thiopurine therapy. In this editorial, we discuss evidence supporting the use of PACSIN2, RAC1, and ITPA genes, in addition to TPMT and NUDT15, as possible biomarkers for thiopurine-related gastrointestinal toxicity.

Automated summary

Thiopurines are effective immunomodulators in treating leukemia and bowel diseases, but adverse reactions can lead to treatment discontinuation. Myelosuppression and gastrointestinal toxicity are common adverse effects, and identifying biomarkers to prevent and monitor these reactions is crucial for clinicians managing patients. Using PACSIN2, RAC1, ITPA genes, along with TPMT and NUDT15, as potential biomarkers for thiopurine-related gastrointestinal toxicity is supported by evidence.