Table 2 Patients triggering rule 27 (issued by CPIC) are inferred by the reasoner to be a subclass of patients triggering rule 35 (issued by the Dutch Pharmacogenomics working group, both rules concern the substance azathioprine)

27

Has some TPMT*1 and has some (TPMT*2 or TPMT*3A or TPMT*3B or TPMT*3C or TPMT*4)

If disease treatment normally starts at the “full dose”, consider starting at 30-70% of target dose (e.g., 1–1.5 mg/kg/d), and titrate based on tolerance. Allow 2–4 weeks to reach steady state after each dose adjustment.

35

Has some TPMT*1 and has some (TPMT*2 or TPMT*3 or TPMT*4 or TPMT*5 or TPMT*6 or TPMT*7 or TPMT*8 or TPMT*9 or TPMT*10 or TPMT*11 or TPMT*12 or TPMT*13 or TPMT*14 or TPMT*15 or TPMT*16 or TPMT*17 or TPMT*18)

Select alternative drug or reduce dose by 50%. Increase dose in response of hematologic monitoring and efficacy.