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HLA-DQA1-HLA-DRB1 variants confer susceptibility to pancreatitis induced by thiopurine immunosuppressants.


ABSTRACT: Pancreatitis occurs in approximately 4% of patients treated with the thiopurines azathioprine or mercaptopurine. Its development is unpredictable and almost always leads to drug withdrawal. We identified patients with inflammatory bowel disease (IBD) who had developed pancreatitis within 3 months of starting these drugs from 168 sites around the world. After detailed case adjudication, we performed a genome-wide association study on 172 cases and 2,035 controls with IBD. We identified strong evidence of association within the class II HLA region, with the most significant association identified at rs2647087 (odds ratio 2.59, 95% confidence interval 2.07-3.26, P = 2 × 10(-16)). We replicated these findings in an independent set of 78 cases and 472 controls with IBD matched for drug exposure. Fine mapping of the HLA region identified association with the HLA-DQA1*02:01-HLA-DRB1*07:01 haplotype. Patients heterozygous at rs2647087 have a 9% risk of developing pancreatitis after administration of a thiopurine, whereas homozygotes have a 17% risk.

SUBMITTER: Heap GA 

PROVIDER: S-EPMC6379053 | biostudies-literature | 2014 Oct

REPOSITORIES: biostudies-literature

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HLA-DQA1-HLA-DRB1 variants confer susceptibility to pancreatitis induced by thiopurine immunosuppressants.

Heap Graham A GA   Weedon Michael N MN   Bewshea Claire M CM   Singh Abhey A   Chen Mian M   Satchwell Jack B JB   Vivian Julian P JP   So Kenji K   Dubois Patrick C PC   Andrews Jane M JM   Annese Vito V   Bampton Peter P   Barnardo Martin M   Bell Sally S   Cole Andy A   Connor Susan J SJ   Creed Tom T   Cummings Fraser R FR   D'Amato Mauro M   Daneshmend Tawfique K TK   Fedorak Richard N RN   Florin Timothy H TH   Gaya Daniel R DR   Greig Emma E   Halfvarson Jonas J   Hart Alisa A   Irving Peter M PM   Jones Gareth G   Karban Amir A   Lawrance Ian C IC   Lee James C JC   Lees Charlie C   Lev-Tzion Raffi R   Lindsay James O JO   Mansfield John J   Mawdsley Joel J   Mazhar Zia Z   Parkes Miles M   Parnell Kirstie K   Orchard Timothy R TR   Radford-Smith Graham G   Russell Richard K RK   Reffitt David D   Satsangi Jack J   Silverberg Mark S MS   Sturniolo Giacomo C GC   Tremelling Mark M   Tsianos Epameinondas V EV   van Heel David A DA   Walsh Alissa A   Watermeyer Gill G   Weersma Rinse K RK   Zeissig Sebastian S   Rossjohn Jamie J   Holden Arthur L AL   Ahmad Tariq T  

Nature genetics 20140914 10


Pancreatitis occurs in approximately 4% of patients treated with the thiopurines azathioprine or mercaptopurine. Its development is unpredictable and almost always leads to drug withdrawal. We identified patients with inflammatory bowel disease (IBD) who had developed pancreatitis within 3 months of starting these drugs from 168 sites around the world. After detailed case adjudication, we performed a genome-wide association study on 172 cases and 2,035 controls with IBD. We identified strong evi  ...[more]

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