Cure8 research brief
NUDT15 genotyping can identify people at high risk of severe thiopurine-induced myelosuppression; if cost-effective, testing could change how clinicians choose or dose thiopurines for IBD, potentially preventing serious toxicity.
Clinicians prescribing thiopurines, NHS/payer decision-makers, pharmacogenetics researchers, and patients considering thiopurine treatment (particularly in ancestry groups with higher NUDT15 variant rates).
This study used a decision-tree model comparing current practice (TPMT enzyme activity testing) with strategies that add NUDT15 genotyping, genotype both TPMT and NUDT15, or avoid thiopurines entirely.
The model assessed one-year outcomes from the UK NHS perspective and focused on avoiding severe thiopurine-induced myelosuppression (TIM), accounting for testing and treatment costs.
The authors report that adding NUDT15 genotyping to TPMT testing reduced predicted TIM events and had a modest cost per event avoided compared with current practice; genotyping both TPMT and NUDT15 dominated current practice in the main analysis. Completely avoiding thiopurines and using alternatives was substantially more costly per TIM event avoided.
Results varied by genetic ancestry subgroup and were sensitive to genotyping costs and assumed clinical management.
Model results depend strongly on genotyping costs, assumed changes in prescribing after a positive test, and the one-year time horizon. This is an economic modelling study (not a randomized trial) reporting projected costs and events avoided for the UK NHS.
Review the original publication for the complete reporting, methods, and context.
Funding disclosed by the source: Confidence in concept funding from MRC/UKRI “Developing the case for implementation of NUDT15 pharmacogenetic testing”, award Project No.123068
This Cure8 brief is based on source text from the linked article. Cure8 is informational only and is not a substitute for professional medical advice, diagnosis, or treatment.
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