Dutch pharmacogenetics working group guideline for the gene-drug interaction of ABCG2, HLA-B and Allopurinol, and MTHFR, folic acid and methotrexate

Karel H van der Pol, Marga Nijenhuis, Bianca Soree, Nienke J de Boer-Veger, Anne Marie Buunk, Henk-Jan Guchelaar, Arne Risselada, Ron H N van Schaik, Jesse J Swen, Daan Touw, Jan van der Weide, Roos van Westrhenen, Vera H M Deneer, Elisa J F Houwink, Gerard A Rongen

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

The Dutch Pharmacogenetics Working Group (DPWG) aims to facilitate PGx implementation by developing evidence-based pharmacogenetics guidelines to optimize pharmacotherapy. This guideline describes the gene-drug interaction of ABCG2 with allopurinol, HLA-B with allopurinol, MTHFR with folic acid, and MTHFR with methotrexate, relevant for the treatment of gout, cancer, and rheumatoid arthritis. A systematic review was performed based on which pharmacotherapeutic recommendations were developed. Allopurinol is less effective in patients with the ABCG2 p.(Gln141Lys) variant. In HLA-B*58:01 carriers, the risk of severe cutaneous adverse events associated with allopurinol is strongly increased. The DPWG recommends using a higher allopurinol dose in patients with the ABCG2 p.(Gln141Lys) variant. For HLA-B*58:01 positive patients the DPWG recommends choosing an alternative (for instance febuxostat). The DPWG indicates that another option would be to precede treatment with allopurinol tolerance induction. Genotyping of ABCG2 in patients starting on allopurinol was judged to be 'potentially beneficial' for drug effectiveness, meaning genotyping can be considered on an individual patient basis. Genotyping for HLA-B*58:01 in patients starting on allopurinol was judged to be 'beneficial' for drug safety, meaning it is advised to consider genotyping the patient before (or directly after) drug therapy has been initiated. For MTHFR-folic acid there is evidence for a gene-drug interaction, but there is insufficient evidence for a clinical effect that makes therapy adjustment useful. Finally, for MTHFR-methotrexate there is insufficient evidence for a gene-drug interaction.

Original languageEnglish
Pages (from-to)155-162
Number of pages8
JournalEuropean Journal of Human Genetics
Volume32
Issue number2
Early online date2 Sept 2022
DOIs
Publication statusPublished - 2024

Bibliographical note

Publisher Copyright:
© 2022, The Author(s), under exclusive licence to European Society of Human Genetics.

Funding

This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 668353. The DPWG received funding from the Royal Dutch Pharmacists Association. G.A. Rongen received funding from the ZonMw programme ‘Goed Gebruik Geneesmiddelen’: grant number 848044004 ‘AllopuriNol to treat AtheRosClerosis in patients with Hyperuricemia (ANARCHY)’.

FundersFunder number
Royal Dutch Pharmacists Association
Horizon 2020 Framework Programme668353
Horizon 2020 Framework Programme
ZonMw848044004
ZonMw

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