P792 Breastfeeding in our patients with inflammatory bowel disease

Abstract Background Breastfeeding is one of the most important environmental factors in early childhood for later development of an Inflammatory Bowel Disease. The duration of lactation is essential for it to have a protective effect. In addition to IBD patients, breastfeeding can have a beneficial effect for preventing disease relapse. For these reasons, we plan to know how lactation develops in our group of patients with Inflammatory Bowel Disease (IBD). Methods A retrospective analysis of patients followed by gastroenterology consultations, with established diagnosis of IBD and with at least one gestation, in a period from January 2011 to January 2016. The data were collected a posteriori through two simple questionnaires, one completed by the patient, collecting the type of childbirth and breastfeeding she experienced and factors that influenced it. Another form is filled out by the gastroenterologist recording the characteristics of his inflammatory bowel disease. The data is collected in a structured database in Microsoft Excel and analysed with the SPSS statistic package for Windows. Results Data from 78 patients diagnosed with IBD are analysed from eight public hospitals in our autonomous community. 61.1% of patients have ulcerative colitis and 38.9% Crohn’s disease. The deliveries were mainly vaginal (82%), compared with 18% of caesarean-sections, four of them directly motivated by digestive disease. More than half of patients (57.7%) started breastfeeding after childbirth, 10.25% breastfeeding and 32.05% mixed breastfeeding But only 34.6% reach six months of breastfeeding, reaching 39.7% if we include mixed breastfeeding. In 17 patients (21.8%) their base-based inflammatory bowel disease directly influenced the development of lactation. Pharmacological treatment is the main cause for breastfeeding, followed by disease outbreaks, hospitalisations and surgery. Only 47.4% of the patients stated that in the IBD consultation they were given some information about breastfeeding, although almost all replied that they would have liked to receive it. Conclusion The majority of patients with inflammatory bowel disease in our consultations, do not reach six months of breastfeeding currently recommended by the World Health Organisation, so we have a great opportunity for improvement in this field and as gastroenterologists, we can contribute by providing more information to our patients about breastfeeding and its relationship with IBD.

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Biosimilars of Adalimumab in Inflammatory Bowel Disease: Are we Ready for that?

Current Pharmaceutical Design ◽

10.2174/1381612825666190312113610 ◽

2019 ◽

Vol 25 (1) ◽

pp. 7-12 ◽

Cited By ~ 4

Author(s):

Marjorie Argollo ◽

Gionata Fiorino ◽

Daniela Gilardi ◽

Federica Furfaro ◽

Giulia Roda ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Health Care Providers ◽

Bowel Disease ◽

Biological Treatment ◽

Reference Product ◽

European Medicines Agency ◽

Care Providers ◽

Inflammatory Bowel ◽

To Receive ◽

The Ideal

Introduction: Biosimilars present a considerable potential to reduce costs related to clinical management allowing health-care providers to reinvest this money, leading to a wider access to an effective biological treatment with monoclonal antibodies (mAb). Infliximab biosimilars have already been incorporated in daily clinical practice and are currently used in all indications for which the reference product (RP) was approved. Areas covered: In the next few years, also adalimumab biosimilars will become available for the treatment of inflammatory bowel disease (IBD). In fact, several of them (ABP501, BI 695501, GP2017, and SB5) have been approved by the European Medicines Agency (EMA) with the same indications of the reference product (Humira ®). Initial preclinical data proved a strong similarity between all biosimilars and the RP. Moreover, phase 3 studies in rheumatoid arthritis and psoriasis showed no differences in terms of efficacy, safety, and immunogenicity. Data on IBD patients are urgently needed. Expert opinion: Biosimilars of adalimumab showed equivalent clinical efficacy to the RP in other immunemediated diseases. However, defining the ideal patient’s profile to receive or to be switched to a biosimilar, choosing one biosimilar vs. another, or cross-switching among biosimilars, will become the next challenge in IBD.

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Endoscopic Resections in Inflammatory Bowel Disease: A Multicentre European Outcomes Study

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz075 ◽

2019 ◽

Vol 13 (11) ◽

pp. 1394-1400

Author(s):

A Alkandari ◽

S Thayalasekaran ◽

M Bhandari ◽

A Przybysz ◽

M Bugajski ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Endoscopic Resection ◽

Bowel Disease ◽

En Bloc ◽

Increased Risk ◽

Delayed Perforation ◽

Inflammatory Bowel ◽

Outcomes Study ◽

Almost All ◽

Current Guidelines

Abstract Background and Aims Inflammatory bowel disease is associated with an increased risk of colorectal cancer, with estimates ranging 2–18%, depending on the duration of colitis. The management of neoplasia in colitis remains controversial. Current guidelines recommend endoscopic resection if the lesion is clearly visible with distinct margins. Colectomy is recommended if complete endoscopic resection is not guaranteed. We aimed to assess the outcomes of all neoplastic endoscopic resections in inflammatory bowel disease. Methods This was a multicentre retrospective cohort study of 119 lesions of visible dysplasia in 93 patients, resected endoscopically in inflammatory bowel disease. Results A total of 6/65 [9.2%] lesions <20 mm in size were treated by ESD [endoscopic submucosal dissection] compared with 59/65 [90.8%] lesions <20 mm treated by EMR [endoscopic mucosal resection]; 16/51 [31.4%] lesions >20 mm in size were treated by EMR vs 35/51 [68.6%] by ESD. Almost all patients [97%] without fibrosis were treated by EMR, and patients with fibrosis were treated by ESD [87%], p < 0.001. In all, 49/78 [63%] lesions treated by EMR were resected en-bloc and 27/41 [65.9%] of the ESD/KAR [knife-assisted resection] cases were resected en-bloc, compared with 15/41 [36.6%] resected piecemeal. Seven recurrences occurred in the cohort. Seven complications occurred in the cohort; six were managed endoscopically and one patient with a delayed perforation underwent surgery. Conclusions Larger lesions with fibrosis are best treated by ESD, whereas smaller lesions without fibrosis are best managed by EMR. Both EMR and ESD are feasible in the management of endoscopic resections in colitis.

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COVID-19 Vaccine Hesitancy among Patients with Inflammatory Bowel Disease Receiving Biologic Therapies in Kuwait: A Cross-Sectional Study

Vaccines ◽

10.3390/vaccines10010055 ◽

2021 ◽

Vol 10 (1) ◽

pp. 55

Author(s):

Mohammad Shehab ◽

Yasmin Zurba ◽

Ali Al Abdulsalam ◽

Ahmad Alfadhli ◽

Sara Elouali

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Cross Sectional Study ◽

Biologic Therapies ◽

Sectional Study ◽

Cross Sectional ◽

Female Patients ◽

Inflammatory Bowel ◽

To Receive

Background: COVID-19 vaccinations have been shown to be effective in reducing risk of severe infection, hospitalization, and death. They have also been shown to be safe and effective in patients with inflammatory bowel disease (IBD) who are receiving biologic therapies. In this study, we aimed to evaluate the prevalence of vaccination among patients receiving biologic therapies for IBD. Methods: A single-center prospective cross-sectional study conducted at a tertiary care inflammatory bowel disease center in Kuwait. Data from patients with inflammatory bowel disease (IBD) who attended the gastroenterology infusion clinic from 1 June 2021 until 31 October 2021 were retrieved. Patients who received infliximab or vedolizumab at least six weeks before recruitment were included. The primary outcome was prevalence of COVID-19 vaccination. The secondary outcome was to assess whether prevalence of COVID-19 vaccination differed based on sex, age, type of biologic therapy and nationality. Results: The total number of inflammatory bowel disease (IBD) patients enrolled in the study was 280 (56.0% male and 44.0% female). Of the total, 112 (40.0%) patients were diagnosed with ulcerative colitis and 168 (60.0%) with Crohn’s disease. The number of ulcerative colitis patients who were vaccinated was 49 (43.8%) and the number of Crohn’s disease patients who were vaccinated was 68 (40.5%). The median age was 33.2 years and BMI was 24.8 kg/m2. With respect to the total number of patients, 117 (41.8%) were vaccinated with either BNT162b2 or ChAdOx1 nCoV-19 and 163 (58.2%) were not vaccinated. Female patients were more likely to receive the vaccine compared to male patients (83.0% vs. 63.8%, p < 0.001). In addition, patients above the age 50 were more likely to receive the vaccine than patients below the age of 50 (95.6% vs. 31.2% p < 0.001). Expatriates were more likely to receive the vaccine than citizens (84.8% vs. 25.0%, p < 0.001). There was no statistical difference between patients on infliximab and vedolizumab with regard to prevalence of vaccination (40.0% vs 48.0%, p = 0.34). Conclusion: The overall prevalence of COVID-19 vaccination among patients with inflammatory bowel disease (IBD) on biologic therapies was lower than that of the general population and world health organization (WHO) recom-mendation. Female patients, patients above the age of 50, and expatriates were more likely to receive the vaccine. Physicians should reinforce the safety and efficacy of COVID-19 vaccines among patients, especially IBD patients on biologic therapies, who express hesitancy towards them.

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Carbohydrate Monotony as Protection and Treatment for Inflammatory Bowel Disease

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz011 ◽

2019 ◽

Vol 13 (7) ◽

pp. 942-948 ◽

Cited By ~ 6

Author(s):

Savini Britto ◽

Richard Kellermayer

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Common Element ◽

Dietary Interventions ◽

Paleolithic Diet ◽

Exclusive Enteral Nutrition ◽

Inflammatory Bowel ◽

Total Fat ◽

Dietary Treatments ◽

To Receive

Abstract The nutritional developmental origins of inflammatory bowel disease[s] (IBDs: Crohn’s disease or Crohn disease [CD] and ulcerative colitis [UC]) and their diet-based treatments continue to receive increasing attention. There is growing evidence for the success of nutrition-based treatments, such as exclusive enteral nutrition [EEN] and the specific carbohydrate diet [SCD], in both paediatric and adult patients. Beyond these two dietary interventions, symptomatic benefit in IBD has also been shown from a gluten-free diet [GFD] and paleolithic diet [PALEO], among others. These nutritional therapies may point to critical factors in not only the pathology, but also the pathogenesis of the disease group. It is difficult, however, to discern a common element within the large number of diet-based causation theories [e.g. emulsifiers, processed foods, refrigeration, increased total fat intake, low fibre intake, carbohydrate dominant food, etc.] and the varied dietary treatments of IBD. This Viewpoint article highlights that carbohydrate variation links diet-based causation theories, and that carbohydrate monotony or persistence is the commonly shared characteristic of diet-based IBD therapy. Further research directed towards carbohydrate monotony may critically advance the prevention and treatment of these highly morbid conditions.

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Rehospitalization rates, costs, and risk factors for inflammatory bowel disease: a 16-year nationwide study

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284820923836 ◽

2020 ◽

Vol 13 ◽

pp. 175628482092383

Author(s):

Mafalda Santiago ◽

Fernando Magro ◽

Luís Correia ◽

Francisco Portela ◽

Paula Ministro ◽

...

Keyword(s):

Risk Factors ◽

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Primary Diagnosis ◽

National Registry ◽

Public Hospitals ◽

Central Administration ◽

Rehospitalization Rate ◽

Mainland Portugal ◽

Inflammatory Bowel

Aims: We aimed to describe the burden of rehospitalization in patients with inflammatory bowel disease (IBD), by evaluating rehospitalization rates, charges, and risk factors over 16 years. Methods: We performed a retrospective analysis of all hospital discharges with a primary diagnosis of IBD in public hospitals between 2000 and 2015 in mainland Portugal from the Central Administration of the Health System (ACSS)’s national registry. We collected data on patient, clinical, and healthcare charges. We used survival analysis to estimate the rate and risk factors of IBD-related rehospitalization. Results: We found that 33% ( n = 15,931) of the IBD-related hospitalizations corresponded to rehospitalizations, which increased by 12% over 16 years. However, IBD rehospitalization rate per 100,000 IBD patients decreased 2.5-fold between 2003 and 2015. Mean IBD-related rehospitalization charges were €14,589/hospitalization-year in 2000 and €17,548 /hospitalization-year in 2015, with total rehospitalization charges reaching €3.1 million/year by 2015. Overall, the 30-day rate of rehospitalization was 24% for Crohn’s disease (CD) and 22.4% for ulcerative colitis (UC). Novel risk factors for rehospitalization include penetrating disease in CD patients {hazard ratio (HR) 1.34 [95% confidence interval (CI) 1.20–1.51], p < 0.001} and colostomy in UC patients [HR 2.84 (95% CI 1.06–7.58)]. Conclusion: IBD-related rehospitalization should be closely monitored, and efforts to reduce its risk factors should be made to improve the quality of care and, consequently, to reduce the burden of IBD.

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P666 Frequency and outcome of SARS-CoV2 infection in patients with inflammatory bowel disease on different biological therapy

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.786 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S590-S591

Author(s):

T Resál ◽

K Farkas ◽

T Molnár

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Biological Therapy ◽

Biologic Therapy ◽

Hospitalization Rate ◽

World Health ◽

Tnf Inhibitor ◽

International Data ◽

Inflammatory Bowel ◽

The Impact

Abstract Background Since almost its 1 year outbreak declared by the World Health Organization on 11th March 2020, COVID-19 pandemic still cannot be controlled successfully. Inflammatory bowel disease potentially elevates the risk of infections, independently from the age, while disease activity and medical treatment(s) can increase the risk as well. Based on international data, in total, 4% receives the infection. Furthermore, 1.8% of the patients on biologic therapy needs intensive therapeutic care and 1% passes away. Methods This was an observational, questionnaire based study, carried out in Hungary, between February and March 2021. Our questionnaire consisted of 45 questions, that surveyed the impact of the pandemic among IBD patients, and the severity and outcome of the infection. Participants were on biologic therapy. Our aim was to determine the frequency and outcome of SARS-CoV2 infection in patients with inflammatory bowel disease on different biological therapy. Results In total, 387 respondents completed the questionnaire, and 47 participants (12%) developed COVID-19 infection. 66.9% of them were receiving anti-TNF inhibitor, 16.8% vedolizumab, 12.1% ustekinumab, and 4.1% tofacitinib. Based on our cohort, different biologic therapies didn’t elevate the risk of infection (p=0.3486), nor the hospitalization rate (p=0.277). No one was in ICU or ventilator, and nobody passed away. Furthermore, 38.3% suspended the current biologic therapy, but it didn’t decrease the rate of hospitalization (p=0.533), however, it didn’t cause flare-ups either in the primary disease (p=0.415). Based on our cohort, neither vitamin supplementations meant protection against the infection (p=0.117), only regular mask wearing seems to protect patients with IBD (p=0.009). Conclusion Based on our cohort, more IBD patients develop the infection in Hungary, compared to international data, however, the outcome of the infection is more favourable. It seems, that the different biological treatments don’t affect the infection rate, and neither elevates the hospitalization rate. In generally, there is no need to suspend the current biologic therapy, however, it should be a matter of individual judgment. After all, we claim that mask-wearing still seems to be the most effective form of prevention.

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P626 SARS-CoV-2 seroprevalence in patients with Inflammatory Bowel Disease

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.746 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S564-S564

Author(s):

S García Mateo ◽

S J Martínez-Domínguez ◽

M C Aso Gonzalvo ◽

C J Gargallo-Puyuelo ◽

B Gallego Llera ◽

...

Keyword(s):

Risk Factors ◽

Inflammatory Bowel Disease ◽

Potential Risk ◽

Bowel Disease ◽

Biologic Agents ◽

World Health ◽

Indeterminate Colitis ◽

Increased Risk ◽

Potential Risk Factors ◽

Inflammatory Bowel

Abstract Background Patients with Inflammatory Bowel Disease (IBD) suffer from a chronic illness and many of them need immunosuppressive therapy throughout the course of the disease. Consequently, COVID-19 pandemic has caused uncertainty about the possible increased risk of suffering SARS-CoV-2 infection that could confer IBD or its treatments. The aim of this study is to assess SARS-CoV-2 seroprevalence in patients with IBD as well as the existence of potential risk factors for its development. Methods This is a unicentric cross-sectional study developed in IBD unit of University Hospital “Lozano Blesa” of Zaragoza. Patients older than 18 years with established diagnosis of Crohn′s Disease (CD), Ulcerative Colitis (UC) or Indeterminate Colitis (IC) have been included. A blood sample has been drawn from each patient to detect IgG against SARS-CoV-2 (ELISA method) and each patient has completed a questionnaire to know symptoms related to infection and previous comorbidity. We have performed a descriptive analysis and a univariate analysis to study relationship between potential risk factors and seroconversion against SARS-CoV-2. Results 431 patients have been included, with a mean age of 50.2 ± 14.1 years and a 51.3% of women. Of them, 49.7% suffer from UC, 49.2% CD and 1.2% IC. Related to the treatment, 23.5% receive anti-TNF biologic agents, 13.1% other kind of biologic agents, 9.3% immunomodulators, 7.7% combined treatment (biologic agent and immunomodulator), 33.1% other treatment and 13.3% no treatment. According to World Health Organization (WHO) definitions, 85.6% had not suffered the infection, 7.7% were confirmed cases (only 3 admitted patients) and 6.7% were probable cases. The seroprevalence of SARS-CoV-2 obtained is 8.8%, being significantly higher among confirmed cases than among probable cases (71.0% in confirmed vs 6.9% in probable; RR 10.3; p<0.001). A higher risk of seroconversion has been detected among patients without biologic agents (11.8% in patients without biologic agents vs 5.3% in patients with biologic agents; RR 2.2; p=0.021). No differences have been observed in the seroprevalence of patients with other treatments for IBD or in terms of age, active smoking, level of inflammation markers, the presence of symptoms of infection or hospital admission. Conclusion The seroprevalence of SARS-CoV-2 of Aragon′s patients with IBD is similar to that described in national seroprevalence study of Ministry of Health for the region (8.8%). The treatment with biologic agents is associated with a lower risk of seroconversion

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P601 Are Inflammatory Bowel Disease patients’ expectations met by dietetic services?

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.722 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S547-S547

Author(s):

N McCarthy ◽

M Schultz ◽

C Wall

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Nutrition Information ◽

Electronic Survey ◽

Low Residue Diet ◽

Specialist Knowledge ◽

Inflammatory Bowel ◽

Almost All ◽

Qualitative Responses ◽

Specific Diet

Abstract Background Guidelines recommend that Inflammatory Bowel Disease (IBD) patients should have access to specialised dietitian support. Literature suggests that patients are often dissatisfied with their access to reliable nutrition information and dietitian services. Our aim was to assess whether New Zealand (NZ) dietetic services were meeting the expectations of patients. Methods In early 2020 an electronic survey to explore experience of dietetic services was disseminated to approximately 2000 patients (and parents) by Crohn’s and Colitis NZ and IBD health professionals. Quantitative responses were analysed via non-parametric methods and qualitative responses were analysed via inductive analysis. Results Responses were received from 407 IBD patients. Participants were asked if it ‘is useful for patients diagnosed with IBD to have access to a dietitian for nutrition advice?’ with 86% responding ‘Yes’ and 12% ‘Maybe’. Almost all (95%) patients had nutrition topics that they would like to discuss with a dietitian but only 52% had seen a dietitian and 45% had never been referred. Patients were interested in various nutrition topics (Table 1). Most (65%) would like access to a dietitian whenever a new nutrition issue arises. The most frequent nutrition advice received was to follow a specific diet, most commonly a low fermentable carbohydrate diet followed by a low residue diet, or general nutrition advice. Two-thirds (66%) of respondents found the dietitian advice at least moderately useful while 18% reported it was not at all useful. Patients who saw a dietitian in a private clinic were more likely to find the advice useful (p=0.0001), as were those who had received written advice (p<0.0001). Common themes in response to open-ended questions included: frustration at difficulty accessing dietetic services; desire for routine dietitian referral at diagnosis and ongoing access; the need for dietitians to have specialist knowledge of IBD; a perception that some medical staff believe nutrition is not relevant in IBD management. Conclusion Many patients have never been referred to a dietitian and a proportion of patients did not find dietitian advice useful. Dietitian advice appears to be on the topics most commonly of interest to patients. Access to dietetic services needs to improve and exploration is needed to elucidate why some aspects of services are not meeting patient expectations.

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Anemia in Crohn’s Disease—The Unseen Face of Inflammatory Bowel Disease

Medicina ◽

10.3390/medicina57101046 ◽

2021 ◽

Vol 57 (10) ◽

pp. 1046

Author(s):

Mihaela Dranga ◽

Lucian Vasile Boiculese ◽

Iolanda Popa ◽

Mariana Floria ◽

Oana Gavril ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Activity ◽

Bowel Disease ◽

Clinical Manifestations ◽

World Health ◽

Tertiary Center ◽

Inflammatory Bowel ◽

The Impact

Background and Objectives: Anemia is the most frequent complication of inflammatory bowel diseases. Clinically, anemia can affect important quality-of-life (QoL) components, such as exercise capacity, cognitive function, and the ability to carry out social activities. The disease activity has a significant impact on QoL, mainly due to clinical manifestations, which are more severe during the periods of disease activity. Our aim was to estimate the impact of anemia on QoL in patients with Crohn’s disease. Material and Methods. We made a prospective study on 134 patients with Crohn’s disease (CD) in a Romanian tertiary center. The CD diagnosis was established by colonoscopy and histopathological examination. In particular cases, additional examinations were required (small bowel capsule endoscopy, computed tomography enterography, and magnetic resonance enterography). Anemia was defined according to the World Health Organization’s definition, the activity of the disease was assessed by Crohn’s disease activity index (CDAI) score, and the QoL was evaluated by Inflammatory Bowel Disease Questionnaire 32 (IBDQ 32). Results: 44.8% patient had anemia, statistically related to the activity of the disease and corticoids use. We found a strong association between QoL and disease activity on all four sub-scores: patients with more severe activity had a significantly lower IBDQ (260.38 ± 116.96 vs. 163.85 ± 87.20, p = 0.001) and the presence of anemia (127.03 vs. 148.38, p = 0.001). In multiple regression analyses, both disease activity and anemia had an impact on the QoL. Conclusions: Anemia has high prevalence in the CD in northeastern region of Romania. Anemia was more common in female patients, in patients undergoing corticosteroid treatment, and in those with active disease. Both anemia and disease activity had a strong negative and independent impact on QoL.

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NUDT15 gene variants and thiopurine-induced leukopenia in patients with inflammatory bowel disease

Intestinal Research ◽

10.5217/ir.2020.00002 ◽

2020 ◽

Vol 18 (3) ◽

pp. 275-281

Author(s):

Katsuyoshi Matsuoka

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Antibody Therapy ◽

Guanosine Monophosphate ◽

Nudix Hydrolase ◽

Risk Alleles ◽

Antidrug Antibody ◽

Inflammatory Bowel ◽

The Stability ◽

Almost All

Thiopurine has been used to maintain remission and to reduce antidrug antibody formation in monoclonal antibody therapy in patients with inflammatory bowel disease (IBD). The use of thiopurine is limited by side effects such as leukopenia. Thiopurine S-methyltransferase (TPMT) variants are associated with thiopurine-induced leukopenia in Westerners, but the frequency of the risk alleles is low in Asians. Recently, a variant in the nudix hydrolase 15 (NUDT15) gene (R139C, c.415C > T) was reported to be associated with early severe leukopenia in Asians. NUDT15 is an enzyme that converts 6-thio-(deoxy)guanosine triphosphate (6-T(d)GTP) to 6-thio-(deoxy)guanosine monophosphate (6-T(d)GMTP). The R139C variant impairs the stability of the protein and increases incorporation of 6-TGTP and 6-TdGTP into RNA and DNA, respectively, resulting in leukopenia. The frequency of C/C, C/T, and T/T are approximately 80%, 20%, and 1%, respectively in East Asians. Early leukopenia occurred in less than 3% of patients with C/C and in around 20% of those with C/T, whereas it occurred in almost all patients with T/T. Patients homozygous for this variant also develop severe hair loss. The measurement of NUDT15 R139C can increase the safety of thiopurine dramatically and is a successful example of personalized medicine in the field of IBD.

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