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Lancet (London, England) Aug 1980
Comparative Study
Topics: Azathioprine; Crohn Disease; Humans; Mercaptopurine; Risk
PubMed: 6105443
DOI: No ID Found -
Biomedicine & Pharmacotherapy =... Apr 2018Azathioprine (AZA) is a well-known immunosuppressant used for many years for its ability to ensure long term disease remission in inflammatory bowel diseases (IBD) at an... (Review)
Review
Azathioprine (AZA) is a well-known immunosuppressant used for many years for its ability to ensure long term disease remission in inflammatory bowel diseases (IBD) at an affordable cost to the public. However, the side effect profile has raised many concerns with numerous investigations into the risk, cause and prevention of these effects. Much of the side effect profile of AZA can be linked to a single nucleotide polymorphism (SNP) in the thiopurine methyltransferase (TPMT) gene which ensures the breakdown and efficacy of AZA. Mutated TPMT alleles result in low or deficient TPMT levels which directly correlate to cytotoxity. This is a review of the role of AZA in the treatment of IBD. Knowing a patient's TPMT status allows the prescribing doctor to make an informed decision about dosage and be more alert to the signs of cytotoxicity. It is essential to include "early warning" SNP testing into common practice to ensure therapeutic efficacy.
Topics: Azathioprine; Humans; Immunosuppressive Agents; Inflammatory Bowel Diseases; Methyltransferases; Polymorphism, Single Nucleotide; Remission Induction
PubMed: 29421584
DOI: 10.1016/j.biopha.2018.01.152 -
Drug Metabolism Reviews 1985
Review
Topics: Animals; Azathioprine; Biotransformation; DNA; DNA Replication; Humans; Immune System Diseases; Mercaptopurine; Neoplasms; Structure-Activity Relationship
PubMed: 3905317
DOI: 10.3109/03602538508991433 -
Annals of Neurology Jun 1984Twenty-four patients with myasthenia gravis were treated with azathioprine. Eighteen of the patients tolerated the drug. Six discontinued azathioprine therapy because of...
Twenty-four patients with myasthenia gravis were treated with azathioprine. Eighteen of the patients tolerated the drug. Six discontinued azathioprine therapy because of toxicity. Of the 18 patients, 15 (83%) improved while receiving azathioprine; in 8 (44%) improvement was felt to result solely from azathioprine. Initial response was seen after 4 to 10 months of treatment, with a mean of 6.4 months. Patients continued to improve for up to 24 months, with the mean time of peak improvement being 14 months. Relapse occurred within one year in all 6 patients in whom azathioprine administration was discontinued. Azathioprine is a reasonable alternative to corticosteroids in selected myasthenic patients requiring immunosuppression.
Topics: Adult; Aged; Azathioprine; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Myasthenia Gravis; Prednisone; Recurrence
PubMed: 6742794
DOI: 10.1002/ana.410150615 -
The Annals of Pharmacotherapy Mar 2011To report a case of drug-induced fever associated with azathioprine treatment in a patient with sarcoidosis.
OBJECTIVE
To report a case of drug-induced fever associated with azathioprine treatment in a patient with sarcoidosis.
CASE SUMMARY
A 52-year-old man with pulmonary sarcoidosis presented to the emergency department with a 1-day history of fever (temperature 39.9 °C), chills, nausea, and vomiting. One week earlier, azathioprine 50 mg/day had been started for worsening dyspnea. The patient was admitted and evaluated for acute infectious processes. All of his home medications (hydroxychloroquine, prednisone, fluticasone/salmeterol, lovastatin, pantoprazole, zolpidem, ibandronate, albuterol), except prednisone, were held. Results of chest X-ray, viral cultures, and urine and blood cultures revealed no source of infection. The patient's temperature returned to normal within 30 hours after discontinuation of azathioprine; rechallenge was not performed.
DISCUSSION
Fever as an adverse drug reaction is often unrecognized, particularly in medically complex patients. Azathioprine has been reported to cause drug fever in patients with inflammatory bowel disease and in those with rheumatoid arthritis; to our knowledge, there have been no previous reports documenting azathioprine-induced fever in patients with sarcoidosis. The chronological course of febrile response and defervescence is highly suggestive of drug-induced fever.
CONCLUSIONS
The rapid resolution of fever after discontinuation of azathioprine suggests that it was the likely source of fever in this patient. If azathioprine is increasingly prescribed in patients with sarcoidosis, fever as an adverse reaction may become more common.
Topics: Azathioprine; Fever; Humans; Immunosuppressive Agents; Male; Middle Aged; Sarcoidosis
PubMed: 21343403
DOI: 10.1345/aph.1P669 -
Cancer Research Jan 1976Azathioprine (6-[(1-methyl-4-nitroimidazol-5-yl)thio]purine; lmuran) is mutagenic for Salmonella typhirmuium. Demonstration of this mutagenic effect requires a period of...
Azathioprine (6-[(1-methyl-4-nitroimidazol-5-yl)thio]purine; lmuran) is mutagenic for Salmonella typhirmuium. Demonstration of this mutagenic effect requires a period of anaerobic incubation of the bacteria with the test agent.
Topics: Anaerobiosis; Azathioprine; Mutation; Salmonella typhimurium
PubMed: 764967
DOI: No ID Found -
Revue de L'infirmiere Apr 2009
Topics: Azathioprine; Humans; Immunosuppressive Agents; Leukopenia; Transplantation Immunology
PubMed: 19469139
DOI: No ID Found -
World Journal of Gastroenterology Jul 2013Underdiagnosis of drug-induced fever leads to extensive investigation and prolongation of hospitalization, and may lead to multiple unnecessary invasive procedures and a...
Underdiagnosis of drug-induced fever leads to extensive investigation and prolongation of hospitalization, and may lead to multiple unnecessary invasive procedures and a wrong diagnosis. Azathioprine is a widely used immunosuppressive drug. We report a case of a 53-year-old female patient diagnosed with autoimmune hepatitis treated with azathioprine, who presented to the emergency room with a 6-wk history of fever and chills without other associated symptoms. Since the patient's fever was of unknown origin, she was hospitalized. All treatment was stopped and an extensive workup to explore the source of fever and chills was performed. Results of chest X-ray, viral, urine, and blood cultures, autoimmune serology, transthoracic and transesophageal echocardiography, and abdominal ultrasound revealed no source of infection. A rechallenge test of azathioprine was performed and the fever and chills returned within a few hours. Azathioprine was established as the definite cause following rechallenge. Fever as an adverse drug reaction is often unrecognized. Azathioprine has been reported to cause drug-induced fever in patients with inflammatory bowel disease, rheumatoid arthritis, and sarcoidosis. To the best of our knowledge there have been no previous reports documenting azathioprine-induced fever in patients with autoimmune hepatitis. The occurrence of fever following the readministration of azathioprine suggests the diagnosis of drug-induced fever, particularly after the exclusion of other causes. A careful rechallenge is recommended to confirm the diagnosis.
Topics: Azathioprine; Female; Fever; Hepatitis, Autoimmune; Humans; Immunosuppressive Agents; Middle Aged; Withholding Treatment
PubMed: 23840156
DOI: 10.3748/wjg.v19.i25.4083 -
Cardiovascular & Hematological... 2020Pure Red Cell Aplasia (PRCA) is a clinical entity comprising severe normochromic normocytic anemia, reticulocytopenia, erythroblastopenia in the bone marrow, with normal...
BACKGROUND
Pure Red Cell Aplasia (PRCA) is a clinical entity comprising severe normochromic normocytic anemia, reticulocytopenia, erythroblastopenia in the bone marrow, with normal leukocyte and platelets count. PRCA can be classified into congenital and acquired, with the latter characterized as idiopathic or secondary to various infections, hematological malignancies, collagen vascular diseases, thymoma, and exposure to a variety of drugs and other chemical substances.
METHODS
Herein, we present a female patient, who presented with PRCA due to azathioprine treatment.
RESULTS
Prompt discontinuation of the drug together with red blood cells transfusions led to complete recovery in this young patient, without any addition of immunosuppressive regimen.
CONCLUSION
We followed 'the wait and see practice' instead of administering immunosuppression to our patient, after careful consideration and extensive consultation with our hematologists. This 'wait and see practice' proved to be effective in the long run.
Topics: Antimetabolites, Antineoplastic; Azathioprine; Female; Humans; Male; Red-Cell Aplasia, Pure
PubMed: 30156166
DOI: 10.2174/1871529X18666180828145818 -
Transplantation May 1996
Topics: Azathioprine; Dose-Response Relationship, Drug; Humans; Immunosuppressive Agents
PubMed: 8629313
DOI: 10.1097/00007890-199605150-00029