Azathioprine

The 1998 document reviews azathioprine, an immunosuppressive drug used for various autoimmune diseases, highlighting its pharmacodynamics, pharmacokinetics, and the importance of pharmacogenetics, particularly TPMT activity, in determining the drug's efficacy and toxicity. It notes that azathioprine is often used off-label and emphasizes the need for monitoring due to its toxicities, such as myelosuppression, carcinogenicity, and rare adverse reactions like severe hypersensitivity and hair loss. The document reports on azathioprine's effectiveness in treating conditions like systemic lupus erythematosus, citing a study of 110 patients, and its use in rheumatoid arthritis, multiple sclerosis, myasthenia gravis, inflammatory bowel diseases, and autoimmune hepatitis. It concludes that more evidence is needed to support the corticosteroid-sparing effect of azathioprine, the impact of patient noncompliance on study outcomes, and recommends TPMT status evaluation before prescribing azathioprine.