Genotype linked to azathioprine discontinuation in patients with lupus and IBD

Researchers have found in a new study that Genotype is linked to azathioprine discontinuation in patients with lupus and IBD.

The retrospective cohort study has found that new thiopurine users with the rs2814778-CC genotype variant, a gene more common in persons of African ancestry, experienced azathioprine discontinuation due to hematopoietic toxicity at an almost 3-fold higher rate than patients with other genotypes. Based on their results, the authors recommend that testing for the Duffy-null phenotype be considered in all patients before azathioprine initiation or if leukopenia is detected while a patient is using azathioprine. The findings are published in Annals of Internal Medicine.

Thiopurine azathioprine, an immunosuppressant used to treat conditions including lupus and inflammatory bowel disease (IBD), has been associated with adverse effects, primarily hematopoietic toxicity. Researchers observed that Black patients discontinued use of azathioprine for hematopoietic toxicity at a higher rate than White patients.

They hypothesized that this difference was associated with the presence of the rs2814778-CC genotype variant independent of race. The variant is found in approximately half of Americans with recent African ancestry and causes lower white blood cell counts without increased risk of infection, also known as benign neutropenia.

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https://www.acpjournals.org/doi/10.7326/M21-4675