P905 Predictive pharmacogenetic risk of pancreatitis in Inflammatory Bowel Disease patients treated with thiopurines: a case-control study from the ENEIDA registry.
Guerra Marina, I.(1)*;Barros, F.(2);Chaparro, M.(3,4);Benítez, J.M.(5);Martín Arranz, M.D.(6);de Francisco, R.(7);Piqueras, M.(8);de Castro, L.(9);Carbajo, A.Y.(10);Bermejo, F.(1);Mínguez, M.(11);Gutiérrez, A.(4,12);Mesonero, F.(13);Cañete, F.(4,14);González-Muñoza, C.(15);Calvo, M.(16);Sicilia, B.(17);Alfambra, E.(4,18);Tardillo, C.A.(19);Rivero, M.(20);Lucendo, A.J.(4,21);Bujanda, L.(4,22);Van Domselaar, M.(23);Almela, P.(24);Ramos, L.(25);Fernández Sánchez, M.(26);Hinojosa, E.(27);Verdejo, C.(28);Gimenez, A.(29);Rodríguez-Lago, I.(30);Manceñido, N.(31);Pérez Calle, J.L.(32);Moreno, M.D.P.(33);Delgado-Guillena, P.G.(34);Antolín, B.(35);Ramírez de la Piscina, P.(36);Casanova, M.J.(3,4);Carracedo, Á.(2);Domènech, E.(4,14);Gisbert, J.P.(3,4);
(1)Hospital Universitario de Fuenlabrada, Gastroenterology, Fuenlabrada, Spain;(2)Fundación Pública Galega de Medicina Xenómica - Sergas, Unidad de Medicina Molecular, Santiago de Compostela, Spain;(3)Hospital Universitario de La Princesa- Instituto de Investigación Sanitaria Princesa IIS-Princesa- UAM, Gastroenterology, Madrid, Spain;(4)Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBEREHD, Gastroenterology, Spain, Spain;(5)Hospital Universitario Reina Sofía e Instituto Maimónides de Investigación Biomédica de Córdoba IMIBIC, Gastroenterology, Córdoba, Spain;(6)Hospital Universitario La Paz, Gastroenterology, Madrid, Spain;(7)Hospital Universitario Central de Asturias- Instituto de Investigación Sanitaria del Principado de Asturias ISPA, Gastroenterology, Oviedo, Spain;(8)Consorci Sanitari Terrasa, Gastroenterology, Terrasa, Spain;(9)Hospital Alvaro Cunqueiro-Complexo Hospitalario Universitario de Vigo- Instituto de Investigación Biomédica Galicia Sur, Gastroenterology, Vigo, Spain;(10)Hospital Universitario Rio Hortega, Gastroenterology, Valladolid, Spain;(11)Hospital Clínico Universitario de Valencia, Gastroenterology, Valencia, Spain;(12)Hospital General Universitario Dr Balmis de Alicante. ISABIAL, Gastroenterology, Alicante, Spain;(13)Hospital Universitario Ramón y Cajal, Gastroenterology, Madrid, Spain;(14)Hospital Universitari Germans Trias i Pujol, Gastroenterology, Badalona, Spain;(15)Hospital de la Santa Creu i Sant Pau, Gastroenterology, Barcelona, Spain;(16)Hospital Universitario Puerta de Hierro-Majadahonda, Gastroenterology, Madrid, Spain;(17)Hospital Universitario de Burgos, Gastroenterology, Burgos, Spain;(18)Hospital Clínico Universitario “Lozano Blesa” e Instituto de Investigación Sanitaria de Aragón IIS Aragón, Gastroenterology, Zaragoza, Spain;(19)Hospital Universitario Nuestra Señora Candelaria, Gastroenterology, Santa Cruz de Tenerife, Spain;(20)Hospital Universitario Marqués de Valdecilla e IDIVAL, Gastroenterology, Santander, Spain;(21)Hospital General de Tomelloso, Gastroenterology, Ciudad Real, Spain;(22)Hospital Donostia/Instituto Biodonostia- Universidad del País Vasco UPV/EHU, Gastroenterology, Donostia/San Sebastian, Spain;(23)Hospital Universitario de Torrejón y Universidad Francisco de Vitoria, Gastroenterology, Madrid, Spain;(24)Hospital General Universitari de Castelló, Gastroenterology, Castelló, Spain;(25)Hospital Universitario de Canarias, Gastroenterology, Santa Cruz de Tenerife, Spain;(26)Hospital General Universitario de Elche, Gastroenterology, Alicante, Spain;(27)Hospital de Manises, Gastroenterology, Valencia, Spain;(28)Hospital General Universitario de Ciudad Real, Gastroenterology, Ciudad Real, Spain;(29)Hospital Sant Joan de Déu-Althaia, Gastroenterology, Manresa, Spain;(30)Hospital de Galdakao, Gastroenterology, Galdakao, Spain;(31)Hospital Universitario Infanta Sofía, Gastroenterology, San Sebastián de los Reyes, Spain;(32)Hospital Universitario Fundación Alcorcón, Gastroenterology, Madrid, Spain;(33)Hospital General La Mancha Centro, Gastroenterology, Alcázar de San Juan- Ciudad Real, Spain;(34)Hospital General de Granollers, Gastroenterology, Granollers, Spain;(35)Hospital Clínico Universitario de Valladolid, Gastroenterology, Valladolid, Spain;(36)Hospital Universitario de Áraba, Gastroenterology, Vitoria, Spain; On behalf of the ENEIDA project of GETECCU.
Background
Treatment with thiopurines may be associated with different adverse effects, including acute pancreatitis. Risk factors for developing pancreatitis due to thiopurines in patients with Inflammatory Bowel Disease (IBD) are not clearly identified, with underlying genetic predisposition being a possible cause. Our aim was to evaluate predictive pharmacogenetic risk of pancreatitis in IBD patients treated with thiopurines.
Methods
IBD patients treated with thiopurines were identified from the prospectively maintained ENEIDA registry of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU). We included as cases those patients who met the Atlanta diagnostic criteria for pancreatitis and had an imaging test that ruled out biliary origin. We included as controls those patients without pancreatitis after at least two years of treatment with thiopurines. Blood samples were collected, and DNA was extracted from leukocytes for all participants and, subsequently, pooled samples were sequenced. Sequencing of a panel of genes (CASR, CEL, CDLN2, CFTR, CPA1, CTRC, PRSS1, and SPINK1) was carried out in the NextSeq500 platform. Variants detected were classified as pathogenic, variants of unknown significance, and benign according to the American College of Medical Genetics and Genomics (ACMGG) guidelines.
Results
Ninety-five cases and 105 controls were enrolled, 57% were women. Pancreatitis was diagnosed at a median age of 39±13 years old. No patient had previous history of chronic or acute pancreatitis. There were no differences between thiopurine-treated patients with and without pancreatitis in age, sex, and age at IBD onset. We identified 81 benign variants (50 in cases and 67 in controls) and a total of 35 distinct rare pathogenic and unknown significance variants (10 in CEL, 21 in CFTR, 1 in CDLN2, and 3 in CPA1). Of these 35 variants (12 in cases and 18 in controls), 6 were classified as pathogenic (1 in cases and 5 in controls), belonging to the CEL and CFTR genes, and 30 as variants of uncertain significance (21 in cases and 22 in controls). There were no significant differences between the groups of cases and controls, both in totals and by genes. None of the cases or controls carried pancreatitis-predisposing variants within the CASR, CPA1, PRSS1, and SPINK1 genes. None of the analysed samples with pancreatitis carried a pathogenic CFTR mutation. Four different variants of unknown significance were detected in the CDLN and CPA1 genes. One of them was in the CDLN gene in a single patient with pancreatitis, and 3 variants in the CPA1 gene in 5 control individuals.
Conclusion
In patients with IBD, there is no predisposition to thiopurine-induced pancreatitis associated with genes known to cause pancreatitis.