Studies to date have focused on the effect of acetylator status and side effects. Kitas et al. (39) found no effect of acetylator status on toxicity or efficacy. Pullar et al. (40) found that there was an increased risk of nausea and vomiting in slow acetylators but no difference in the rates of serious toxicity. Several studies have examined the effect of the N-acetyltrans-ferase 2 (NAT2) polymorphism on treatment outcome. To date, at least 19 SNPs have been identified within the coding region of NAT2 (41). Tanaka et al. (42) studied a Japanese RA cohort and found that patients without the NAT2*4 haplotype, which is associated with rapid acetylation status, had a significantly higher number of adverse events than patients with the NAT2*4 haplotype (62.5% vs. 8.1%; OR 7.73). Sabbagh et al. (43) also found a higher rate of side effects with sulfasalazine in slow acetylators with chronic discoid lupus. However, a study by Ricart et al. (44) in ulcerative colitis patients found no association between NAT2 polymorphisms and sulfasalazine toxicity. Further studies are required to resolve these issues.

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