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• W51580134 abstract "Background Azathioprine (AZA) is a commonly used drug for the management of various rheumatologic disorders. Due to individual variation of the metabolism of AZA, related to genetic polymorphism of the thiopurine methyl transferase (TPMT), serious toxic effects can result if inappropriate dose is administered. AZA dosing according to patients TPMT status can reduce drug-induced morbidity and can be cost effective. Aim To determine the current local practice of AZA dosing, identify AZA-related toxicity and to compare the local practice with the British Society of Rheumatology (BSR) recommendations. Methods Retrospective review of patients on AZA for various rheumatologic conditions from inpatient (n=22) and outpatient (n=38) database at Middlemore Hospital, from January 2003 to January 2007. Data were collected on patient’s demographics, treatment history including AZA dosing regimen, TPMT testing, drugrelated toxicities and their management. Results The mean age was 53 years; 73% were females. 43% of European ethnicity; mean weight of patient was 75±25 kg. 42% had SLE, 22% had rheumatoid arthritis, and 13% had systemic vasculitis. Average initial dose of AZA prescribed was 100±37 mg. 45% developed AZA related toxicity. AZA was withdrawn in 35 % of patients due to drug-related side-effects and inefficacy.15% of the patients required dose reduction. TPMT status was tested in 6 (10%) patients; three had low TMPT level, needing dose reduction. BSR recommendation for AZA dosing was followed in 15% cases. Conclusion A significant proportion of the studied cohort of rheumatologic patients on AZA had drug-related toxicity resulting in discontinuation of AZA. Our data suggests that better pre-treatment assessment including TPMT testing and the practice of guideline based dosing regimen would reduce the incidence of undue side-effects and discontinuation of such treatment. Azathioprine (AZA) and its metabolites 6-mercaptopurine (6MP) are thiopurine drugs used widely in the management of various rheumatologic conditions such as rheumatoid arthritis, systemic lupus erythematosis (notably lupus nephritis), systemic vasculitis and other autoimmune connective tissue disorders. 1,2,3 It is also used in acute lymphoblastic leukaemia, organ transplantation, inflammatory bowel disease and inflammatory dermatologic disease. Azathioprine has no indigenous immunosuppressive activity; it is a prodrug. The first step in biotransformation is non-enzymic cleavage to form mercaptopurine which in" @default.
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• W51580134 date "2010-10-15" @default.
• W51580134 modified "2023-09-26" @default.
• W51580134 title "Outcome of patients on azathioprine: a need for a better pre-treatment assessment and dosing guideline." @default.
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