{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T21:55:09Z","timestamp":1788386109972,"version":"build-2803163510"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T00:00:00Z","timestamp":1738886400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Indian Association of Dermatologists, Venereologists and Leprologists","award":["IRG 25"],"award-info":[{"award-number":["IRG 25"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Polymorphisms in thiopurine methyltransferase (TPMT) are a predominant cause of azathioprine-induced leucopenia in Western countries. The exact role of these polymorphisms in the Indian population with dermatological disorders is uncertain.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To evaluate the frequency of genetic polymorphism of TPMT and its impact on the safety of azathioprine in dermatological disorders.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We included consecutive patients on azathioprine who were initiated for dermatological disorders from South India. Three TPMT polymorphisms (c.238G&amp;gt;C, c.460G&amp;gt;A and c.719A&amp;gt;G) were assessed. The proportions of adverse events to azathioprine, especially myelosuppression, were compared between those with the wildtype genotype and those with TPMT polymorphisms.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of the 123 patients (61 male and 62 female, mean age 46\u2005years), 65% had an autoimmune blistering disorder. Adverse events to azathioprine were noted in 25 (20.3%), of whom 16 (13.0%) had myelosuppression and 4 (3.2%) each had hepatotoxicity and gastrointestinal intolerance. TPMT polymorphisms were detected in 13 (10.6%), of whom 5 had experienced adverse events. The polymorphisms could explain 25% (4 of 16) of the cases of leucopenia. The odds of developing leucopenia in patients with TPMT polymorphism were not significant (odds ratio 3.63, 95% confidence interval 0.96\u201313.6; P = 0.06).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The tested TPMT polymorphisms could not predict the adverse events of azathioprine, particularly the haematological toxicity, in dermatological use among the South Indian population.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ced\/llaf070","type":"journal-article","created":{"date-parts":[[2025,2,8]],"date-time":"2025-02-08T04:03:16Z","timestamp":1738987396000},"page":"1337-1342","source":"Crossref","is-referenced-by-count":2,"title":["Clinical relevance of thiopurine methyltransferase genotype testing for azathioprine in dermatology"],"prefix":"10.1093","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9672-2029","authenticated-orcid":false,"given":"Sivaranjini","family":"Ramassamy","sequence":"first","affiliation":[{"name":"Department of Dermatology, Venereology and Leprosy, Jawaharlal Institute of Postgraduate Medical Education and Research , Pondicherry ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laxmisha","family":"Chandrashekar","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprosy, Jawaharlal Institute of Postgraduate Medical Education and Research , Pondicherry ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayanthi","family":"Mathaiyan","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research , Pondicherry ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8518-5520","authenticated-orcid":false,"given":"Medha","family":"Rajappa","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research , Pondicherry ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reka","family":"Devanathan","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research , Pondicherry ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sujeevan","family":"Selvarathinam","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprosy, Jawaharlal Institute of Postgraduate Medical Education and Research , Pondicherry ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alladi Charanraj","family":"Goud","sequence":"additional","affiliation":[{"name":"Institute of Molecular and Translational Sciences , Olomouc ,","place":["Czech Republic"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,2,7]]},"reference":[{"key":"2025062505025733100_llaf070-B1","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1111\/j.1365-2133.2011.10575.x","article-title":"British Association of Dermatologists\u2019 guidelines for the safe and effective prescribing of azathioprine 2011","volume":"165","author":"Meggitt","year":"2011","journal-title":"Br J Dermatol"},{"key":"2025062505025733100_llaf070-B2","volume-title":"Medical Genetics Summaries","author":"Dean"},{"key":"2025062505025733100_llaf070-B3","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1111\/j.1365-2125.2004.02112.x","article-title":"Thiopurine S-methyltransferase genetic polymorphism in the Thai population","volume":"58","author":"Srimartpirom","year":"2004","journal-title":"Br J Clin Pharmacol"},{"key":"2025062505025733100_llaf070-B4","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1111\/cts.12533","article-title":"Implementation of standardized clinical processes for TPMT testing in a diverse multidisciplinary population: challenges and lessons learned","volume":"11","author":"Weitzel","year":"2018","journal-title":"Clin Transl Sci"},{"key":"2025062505025733100_llaf070-B5","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1093\/hmg\/8.2.371","article-title":"Polymorphism of the thiopurine S-methyltransferase gene in African-Americans","volume":"8","author":"Hon","year":"1999","journal-title":"Hum Mol Genet"},{"key":"2025062505025733100_llaf070-B6","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1097\/00008571-200204000-00003","article-title":"Molecular analysis of thiopurine S-methyltransferase alleles in South-east Asian populations","volume":"12","author":"Chang","year":"2002","journal-title":"Pharmacogenetics"},{"key":"2025062505025733100_llaf070-B7","doi-asserted-by":"crossref","first-page":"6343","DOI":"10.1007\/s11033-012-1456-8","article-title":"Inter and intra-ethnic differences in the distribution of the molecular variants of TPMT, UGT1A1\u00a0and MDR1\u00a0genes in the South Indian population","volume":"39","author":"Umamaheswaran","year":"2012","journal-title":"Mol Biol Rep"},{"key":"2025062505025733100_llaf070-B8","first-page":"121","article-title":"Thiopurine S-methyltransferase alleles, TPMT*2,\u00a0*3B\u00a0and *3C, and genotype frequencies in an Indian population","volume":"1","author":"Murugesan","year":"2010","journal-title":"Exp Ther Med"},{"key":"2025062505025733100_llaf070-B9","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1007\/s12032-009-9331-8","article-title":"Frequency of TPMT\u00a0alleles in Indian patients with acute lymphatic leukemia and effect on the dose of 6-mercaptopurine","volume":"27","author":"Desire","year":"2010","journal-title":"Med Oncol"},{"key":"2025062505025733100_llaf070-B10","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1016\/j.leukres.2010.01.029","article-title":"Thiopurine S-methyltransferase gene polymorphism and 6-mercaptopurine dose intensity in Indian children with acute lymphoblastic leukemia","volume":"34","author":"Kapoor","year":"2010","journal-title":"Leuk Res"},{"key":"2025062505025733100_llaf070-B11","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1111\/j.1365-2230.2009.03446.x","article-title":"An audit of thiopurine methyltransferase genotyping and phenotyping before intended azathioprine treatment for dermatological conditions","volume":"35","author":"Vestergaard","year":"2010","journal-title":"Clin Exp Dermatol"},{"key":"2025062505025733100_llaf070-B12","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1001\/archderm.144.9.1143","article-title":"Role of thiopurine methyltransferase activity in the safety and efficacy of azathioprine in the treatment of pemphigus vulgaris","volume":"144","author":"Firooz","year":"2008","journal-title":"Arch Dermatol"},{"key":"2025062505025733100_llaf070-B13","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1001\/archderm.1995.01690140077013","article-title":"The role of genetic variation in thiopurine methyltransferase activity and the efficacy and\/or side effects of azathioprine therapy in dermatologic patients","volume":"131","author":"Snow","year":"1995","journal-title":"Arch Dermatol"},{"key":"2025062505025733100_llaf070-B14","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1046\/j.1365-2133.2002.04922.x","article-title":"A retrospective evaluation of azathioprine in severe childhood atopic eczema, using thiopurine methyltransferase levels to exclude patients at high risk of myelosuppression","volume":"147","author":"Murphy","year":"2002","journal-title":"Br J Dermatol"},{"key":"2025062505025733100_llaf070-B15","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1093\/rheumatology\/kel427","article-title":"TPMT\u00a0testing in rheumatology: any better than routine monitoring?","volume":"46","author":"Payne","year":"2007","journal-title":"Rheumatology"},{"key":"2025062505025733100_llaf070-B16","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1111\/j.1365-2710.2007.00805.x","article-title":"Current use of pharmacogenetic testing: a national survey of thiopurine methyltransferase testing prior to azathioprine prescription","volume":"32","author":"Fargher","year":"2007","journal-title":"J Clin Pharm Ther"},{"key":"2025062505025733100_llaf070-B17","doi-asserted-by":"crossref","first-page":"529","DOI":"10.5021\/ad.2017.29.5.529","article-title":"Thiopurine S-methyltransferase polymorphisms in Korean dermatologic patients","volume":"29","author":"Lee","year":"2017","journal-title":"Ann 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cohort study","volume":"49","author":"Zhou","year":"2022","journal-title":"J\u00a0Dermatol"},{"key":"2025062505025733100_llaf070-B24","doi-asserted-by":"crossref","first-page":"7984","DOI":"10.1038\/s41598-021-87095-0","article-title":"Association of genetic variants in TPMT, ITPA, and NUDT15 with azathioprine-induced myelosuppression in southwest China patients with autoimmune hepatitis","volume":"11","author":"Miao","year":"2021","journal-title":"Sci Rep"},{"key":"2025062505025733100_llaf070-B25","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1038\/clpt.2010.320","article-title":"Clinical pharmacogenetics implementation consortium guidelines for thiopurine methyltransferase genotype and thiopurine dosing","volume":"89","author":"Relling","year":"2011","journal-title":"Clin Pharmacol Ther"},{"key":"2025062505025733100_llaf070-B26","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1080\/17512433.2021.1900729","article-title":"Prevalence of polymorphisms in thiopurine 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