https://scholars.lib.ntu.edu.tw/handle/123456789/628089
標題: | Implementation of NUDT15 Genotyping to Prevent Azathioprine-Induced Leukopenia for Patients With Autoimmune Disorders in Chinese Population | 作者: | Wang, Chuang-Wei Chi, Min-Hui Tsai, Tsen-Fang Yu, Kuang-Hui Kao, Hsiao-Wen Chen, Hsiang-Cheng Chen, Chun-Bing Lu, Chun-Wei Chen, Wei-Ti Chang, Ya-Ching Chang, Chih-Jung Chang, Yun-Ting Jan Wu, Yeong-Jian Chang, Chee-Jen Huang, Yu Huei Ng, Chau-Yee PO-WEI HUANG Lin, Yu-Jr Hui, Rosaline Chung-Yee Chung, Wen-Hung |
關鍵字: | VARIANT; MYELOSUPPRESSION; SUSCEPTIBILITY; FEATURES; MARKER; COMMON | 公開日期: | 十一月-2022 | 出版社: | WILEY | 卷: | 112 | 期: | 5 | 起(迄)頁: | 1079 | 來源出版物: | Clinical pharmacology and therapeutics | 摘要: | Azathioprine (AZA) is commonly used for many autoimmune disorders; however, the limitation of its clinical use is due to potential toxicities, including severe leukopenia. Recent studies have identified genetic NUDT15 variants strongly associated with AZA-induced leukopenia in Asian patients. This study aimed to investigate the strength of above genetic association and evaluate the usefulness of prospective screening of the NUDT15 variants to prevent AZA-induced leukopenia in Chinese patients. AZA-induced leukopenia in patients with autoimmune disorders were enrolled from multiple medical centers in Taiwan/China between 2012 and 2017 to determine the strength of genetic association of NUDT15 or TPMT variants by whole exome sequencing (WES). Furthermore, a prospective study was conducted between 2018 and 2021 to investigate the incidence of AZA-induced leukopenia with and without genetic screening. The WES result showed the genetic variants of NUDT15 R139C (rs116855232) (P = 3.7 × 10-25 , odds ratio (OR) = 21.7, 95% confidence interval (95% CI) = 12.1-38.8) and NUDT15 rs746071566 (P = 4.2 × 10-9 , OR = 7.1, 95% CI = 3.7-13.7), but not TPMT, were associated with AZA-induced leukopenia and NUDT15 R139C variant shows the highest sensitivity with 92.5%. Furthermore, the targeted screening of 1,013 participants for NUDT15 R139C enabled those identified as carriers to use alternative immunosuppressants. This strategy resulted in a significant decrease in the incidence of AZA-induced leukopenia compared with historical incidence (incidence rate = from 7.6% decreased to 0.4%; P = 9.3 × 10-20 ). In conclusion, the NUDT15 R139C variant was strongly associated with AZA-induced leukopenia in Chinese patients. The genetic screening of NUDT15 R139C followed by use of alternative immunosuppressants in identified carriers effectively decreased the incidence of AZA leukopenia for patients with autoimmune disorders. |
URI: | https://scholars.lib.ntu.edu.tw/handle/123456789/628089 | ISSN: | 0009-9236 | DOI: | 10.1002/cpt.2716 |
顯示於: | 醫學院附設癌醫中心醫院(臺大癌醫) |
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