Abstract
Azathioprine and its metabolite 6-mercaptopurine are effective in the treatment of inflammatory bowel disease. They are mostly used for reduction of the use of steroids, maintenance therapy after remission induction by cyclosporin and treatment of fistulae in Crohn's disease. Adverse effects occur in about 15% of patients. The main side effects are pancreatitis, allergic reactions, fever and bone marrow suppression. Symptoms, management and prevention are discussed. A blood monitoring schedule is suggested. Azathioprine and 6-mercaptopurine seem to be safe in pregnancy. There may be a slight increased risk for developing a non-Hodgkin's lymphoma.
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- Alstead E. M., Ritchie J. K., Lennard-Jones J. E., Farthing M. J., Clark M. L. Safety of azathioprine in pregnancy in inflammatory bowel disease. Gastroenterology. 1990 Aug;99(2):443–446. doi: 10.1016/0016-5085(90)91027-4. [DOI] [PubMed] [Google Scholar]
- Brown G., Boldt C., Webb J. G., Halperin L. Azathioprine-induced multisystem organ failure and cardiogenic shock. Pharmacotherapy. 1997 Jul-Aug;17(4):815–818. [PubMed] [Google Scholar]
- Candy S., Wright J., Gerber M., Adams G., Gerig M., Goodman R. A controlled double blind study of azathioprine in the management of Crohn's disease. Gut. 1995 Nov;37(5):674–678. doi: 10.1136/gut.37.5.674. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Connell W. R., Kamm M. A., Dickson M., Balkwill A. M., Ritchie J. K., Lennard-Jones J. E. Long-term neoplasia risk after azathioprine treatment in inflammatory bowel disease. Lancet. 1994 May 21;343(8908):1249–1252. doi: 10.1016/s0140-6736(94)92150-4. [DOI] [PubMed] [Google Scholar]
- Connell W. R., Kamm M. A., Ritchie J. K., Lennard-Jones J. E. Bone marrow toxicity caused by azathioprine in inflammatory bowel disease: 27 years of experience. Gut. 1993 Aug;34(8):1081–1085. doi: 10.1136/gut.34.8.1081. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Haber C. J., Meltzer S. J., Present D. H., Korelitz B. I. Nature and course of pancreatitis caused by 6-mercaptopurine in the treatment of inflammatory bowel disease. Gastroenterology. 1986 Oct;91(4):982–986. doi: 10.1016/0016-5085(86)90703-1. [DOI] [PubMed] [Google Scholar]
- Jarrett P., Duffill M., Oakley A., Smith A. Pellagra, azathioprine and inflammatory bowel disease. Clin Exp Dermatol. 1997 Jan;22(1):44–45. doi: 10.1046/j.1365-2230.1997.1930606.x. [DOI] [PubMed] [Google Scholar]
- Kinlen L. J. Incidence of cancer in rheumatoid arthritis and other disorders after immunosuppressive treatment. Am J Med. 1985 Jan 21;78(1A):44–49. doi: 10.1016/0002-9343(85)90245-1. [DOI] [PubMed] [Google Scholar]
- Knowles S. R., Gupta A. K., Shear N. H., Sauder D. Azathioprine hypersensitivity-like reactions--a case report and a review of the literature. Clin Exp Dermatol. 1995 Jul;20(4):353–356. doi: 10.1111/j.1365-2230.1995.tb01343.x. [DOI] [PubMed] [Google Scholar]
- Lavaud F., Abdelli N., Thiefin G. Successful desensitization for azathioprine skin rash in a patient with severe Crohn's disease. Dig Dis Sci. 1997 Apr;42(4):823–823. doi: 10.1023/a:1018828517366. [DOI] [PubMed] [Google Scholar]
- Pearson D. C., May G. R., Fick G. H., Sutherland L. R. Azathioprine and 6-mercaptopurine in Crohn disease. A meta-analysis. Ann Intern Med. 1995 Jul 15;123(2):132–142. doi: 10.7326/0003-4819-123-2-199507150-00009. [DOI] [PubMed] [Google Scholar]
- Present D. H., Meltzer S. J., Krumholz M. P., Wolke A., Korelitz B. I. 6-Mercaptopurine in the management of inflammatory bowel disease: short- and long-term toxicity. Ann Intern Med. 1989 Oct 15;111(8):641–649. doi: 10.7326/0003-4819-111-8-641. [DOI] [PubMed] [Google Scholar]
- Roubenoff R., Hoyt J., Petri M., Hochberg M. C., Hellmann D. B. Effects of antiinflammatory and immunosuppressive drugs on pregnancy and fertility. Semin Arthritis Rheum. 1988 Nov;18(2):88–110. doi: 10.1016/0049-0172(88)90002-9. [DOI] [PubMed] [Google Scholar]
- Sandborn W. J. 6-MP metabolite levels: a potential guide to Crohn's disease therapy. Gastroenterology. 1997 Aug;113(2):690–692. doi: 10.1053/gast.1997.v113.agast971130690. [DOI] [PubMed] [Google Scholar]
- Sandborn W. J., Van O E. C., Zins B. J., Tremaine W. J., Mays D. C., Lipsky J. J. An intravenous loading dose of azathioprine decreases the time to response in patients with Crohn's disease. Gastroenterology. 1995 Dec;109(6):1808–1817. doi: 10.1016/0016-5085(95)90747-5. [DOI] [PubMed] [Google Scholar]