A New Frontier in Heart Failure: The 2025 CPIC Guideline for Thiopurine Pharmacogenetics
The Clinical Pharmacogenetics Implementation Consortium (CPIC) has issued a crucial 2025 update to its guideline for dosing thiopurine drugs, including azathioprine. This class of immunosuppressants is sometimes used in cardiovascular conditions, such as in heart transplant recipients or certain inflammatory cardiomyopathies. The guideline provides specific, evidence-based recommendations for adjusting starting doses based on a patient’s genetic profile for two key enzymes: TPMT and NUDT15. Variants in these genes, which vary in frequency across global populations, can lead to dangerously low enzyme activity, resulting in severe adverse effects like life-threatening myelosuppression from standard drug doses.
Why it might matter to you: For cardiologists managing complex patients who require immunosuppression, this guideline is a critical tool for precision medicine. It directly addresses the challenge of balancing therapeutic efficacy against the risk of severe toxicity, a core concern in drug safety and personalized treatment plans. Implementing this genetic testing can refine risk prediction and optimize initial dosing strategies, potentially preventing dangerous complications and improving patient outcomes in specialized cardiovascular care.
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