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Azathioprine

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Azathioprine
A. G. Moore

In my brief article on Plaquenil, I mention that there are bigger guns than this in the rheumatologist’s lupus arsenal. One of the bigger guns is azathioprine. Azathioprine is an immunosuppressant which was designed in 1957 for use in chemotherapy; however, the drug was discovered to be useful in the treatment of some autoimmune diseases, including lupus.

Although today azathioprine is widely accepted as a lupus treatment, the FDA has approved the drug for only two uses: kidney transplants and rhuematoid arthritis. All other uses are considered “off-label”.

Nonetheless, azathioprine can be a powerful ally in the battle against lupus. The drug acts to inhibit cell reproduction, especially reproduction of T and B cells, two lymphocytes implicated in inflammation. Often, azathioprine is given in addition to a steroid. When azathioprine starts to take effect (which may not be for months) steroid use may be reduced or even eliminated.

People taking allopuranol, niacin, warfarin and certain muscle relaxants should be aware that potentially dangerous drug interactions have been observed between these and azathioprine. There is also some evidence that fetal damage may occur, although this is controversial. According to the Mayo Clinic: “Studies in pregnant women have demonstrated a risk to the fetus”. The Mayo site goes on to say that even though a potential risk to the fetus exists, in some cases this may be outweighed by a risk to the mother’s life.

The chances of developing skin cancer rises with azathioprine use, as does the likelihood of developing a rare type of lymphoma. There is also the potential to experience bone marrow suppression and leukopenia.

The side effects listed above are just some, not all, of those that have been noted with azathioprine therapy. That said, this drug can be very useful and effective; it is taken with great benefit by many people. I came across the abstract of an article which describes the success rates for lupus patients who were treated with azathioprine (see Arthritis and Rheumatism, below). People who had begun the drug course with a poor prognosis showed a dramatic increase in survival rates and those with a good prognosis showed a dramatic decrease in hospitalizations.

Although reading about the side effects of a medicine may be upsetting, that shouldn’t dissuade anyone from accepting proper, sometimes aggressive treatment for their disease. As I describe in my book, A Lupus Handbook: These Are the Faces of Lupus, appropriate medical interventions, including powerful drugs, may be all that stands between a lupus patient and good health.

Some informative sites I used in researching the material on azathioprine:

*Mayo Clinic:http://www.mayoclinic.com/health/drug-information/DR601561

*Data Sheet, New Zealand Gov’t :http://www.medsafe.govt.nz/profs/datasheet/i/imuprinetab.pdf

*Arthritis and Rheumatism: http://onlinelibrary.wiley.com/doi/10.1002/art.1780180106/abstract)

 

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