N-acetyltransferase 2 genotype-related efficacy of Sulfasalazine in patients with rheumatoid arthritis

Purpose. For the individual optimization of drug therapy with sulfasalazine ( SASP), we studied the influence of the N-acetyltransferase 2 (NAT2) genotype on the pharmacokinetics, efficacy, and incidence of adverse reactions of SASP in patients. Methods. Ninety-six rheumatoid arthritis ( RA) patients were treated or had been treated with 0.5 and/or 1.0 g/day of SASP. The wild-type allele (NAT2*4) and three variant alleles (NAT2*5B, *6A, and *7B) of NAT2 were determined by the polymerase chain reaction-restriction fragment length polymorphism method. Plasma concentrations of SASP and its two metabolites, sulfapyridine (SP) and N-acetylsulfapyridine (AcSP), were estimated by HPLC. Therapeutic efficacy and incidence of adverse reactions were also monitored as recommended by the American College of Rheumatology. Results. Patients were classified into three groups by NAT2 genotyping: Rapid Type ( homozygote for NAT2*4), Intermediate Type ( heterozygote for NAT2* 4 and variant alleles), and Slow Type ( homozygote for variant alleles). There was no clear difference in the genotype frequencies between RA patients and healthy subjects. NAT2 genotypes significantly affected both the plasma concentration ratios of SP to AcSP (SP/AcSP) and the efficacy of SASP ( p < 0.05). Adverse reactions to SASP were found in 26 (27.1%) out of 96 patients, and there was no difference among the three genotype groups. Conclusions. NAT2 gene polymorphism is related to the plasma SP/ AcSP ratio and the efficacy of SASP.