Pharmacogenomics in the Treatment of Inflammatory Bowel Disease

Abstract

In recent years, the benefits of early aggressive treatment paradigms for inflammatory bowel disease have emerged. Symptomatic improvement is no longer considered adequate; instead, the aim of treatment has become mucosal healing and altered natural history. Nonetheless, we still fail to achieve these end points in a large number of our patients. There are many reasons why patients fail to respond or develop toxicity when exposed to drugs used for inflammatory bowel disease, but genetic variation is likely to account for a significant proportion of this. Some examples, notably thiopurine methyltransferase polymorphism in thiopurine treatment, are already established in clinical practice. We present a review of the expanding literature in this field, highlighting many interesting developments in pharmacogenomics applied to inflammatory bowel disease and, where possible, providing guidance on the translation of these developments into clinical practice.

KEYWORDS::

• 5-aminosalicylate
• 6-mercaptopurine
• azathioprine
• drug metabolism
• inflammatory bowel disease
• infliximab
• methotrexate
• pharmacogenetics
• pharmacogenomics
• steroid
• sulphasalazine

Financial & competing interests disclosure

Melissa Smith is supported by the Purine Research Fund, Guy‘s and St Thomas‘ Charity. The authors have previously received money as an educational grant from Prometheus Laboratories and are involved with them regarding intellectual property. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Additional information

Funding

Melissa Smith is supported by the Purine Research Fund, Guy‘s and St Thomas‘ Charity. The authors have previously received money as an educational grant from Prometheus Laboratories and are involved with them regarding intellectual property. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.