جستجوی مقالات مرتبط با کلیدواژه « azathioprine » در نشریات گروه « پزشکی »
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BackgroundThe effect of the combination of prednisolone, azathioprine, and acetylcysteine for the treatment of Idiopathic pulmonary fibrosis (IPF) is minimal. We aimed to investigate the effect of these drugs in case of intolerance to new anti-fibrotic drugs.Materials and MethodsThis historical prospective study was performed on 91 patients with idiopathic pulmonary fibrosis who were referred to a pulmonologist in Mashhad during 2016-2020. Patients were divided into two groups, Pirfenidone which was prescribed for 46 subjects, and a combination of prednisolone, azathioprine, and acetylcysteine which was prescribed for 45 subjects. Patients were selected by convenience sampling and a life expectancy comparison between the two groups was performed by Cox regression.ResultsThere were no statistically significant differences between age, gender, and drug type in the two groups at the beginning of treatment. The death rate per year in the triple-drug treatment group was 44.44% (n = 20) and in the Pirfenidone treatment group was 11.08% (n=2). Of the 65 recovered population, 49% (22 patients) were in the triple-drug treatment group, and 78% (36 patients) were in the Pirfenidone treatment group which indicated that Pirfenidone has a significant impact on reducing death rate compared to triple-drug treatment (p-value=0.003 <0.05). Pirfenidone decreased the risk of death, compared to triple therapy (0.23 when death was set up as one in the triple-therapy group).ConclusionPirfenidone has a favorable effect on increasing life expectancy and triple therapy should be considered as short-term only in subjects intolerant to anti-fibrotic.Keywords: acetylcysteine, Azathioprine, Idiopathic pulmonary fibrosis, Longevity, Prednisolone, Pirfenidone}
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Govaresh, Volume:26 Issue: 4, Winter 2022, PP 223 -240
Although prescribing biological drugs have been common in Iran for nearly a decade and is now more widely available than ever, some physicians may still be unfamiliar with them. This guideline is the first joint statement of the Iranian Association of Gastroenterologists and Hepatologists (IAGH) regarding the proper use of biological drugs in IBD treatment. Many of the current guidelines are based on internationally published data due to a lack of national and regional information (individual and racial differences affecting patients' responses to biologics as well as characteristics). In this guide, we have tried to address various issues, including the indication for starting biological drugs, contraindications, prevention of complications, screening before starting biological treatment, and other follow-ups during treatment in Crohn's disease and ulcerative colitis. The authors of the article hope that based on these strategies, they will provide helpful information based on scientific evidence to physicians around the country to treat their patients with biological drugs successfully. As far as we know, this consensus on the starting and continuing of biologics is the first case to be compiled and published on the use of biological drugs in Iran, and it shows the importance of its application. However, the physicians’ decision about treating their patients is a priority. Naturally, it will be necessary to review the provisions of this agreement after the next 2-3 years.
Keywords: Adalimumab, Azathioprine, Biosimilar, Crohn’s disease, Inflammatory bowel disease, Infliximab, Methotrexate, Ulcerative colitis, Surgery, Tofacitinib, Iran Publication types: Consensus development conference, Practice guideline} -
IntroductionBehçet’s syndrome (BS) is a systemic vasculitis characterized by skin involvement, uveitis, and arthritis. Azathioprine is an effective therapy among other immunosuppressive drugs for this disease but there is no clear data about all aspects of its side effects in BS patients with ocular manifestations. we want to determine the prevalence and types of adverse effects related with azathioprine in ocular BS patients.Methodsthe study is cross-sectional with 165 confirmed diagnosis of BS patients who had ocular involvement. Data were collected retrospectively with medical records of the BS clinic.ResultsOf 165 enrolled patients, Adverse events of treatment with azathioprine occurred in 11 patients (6.67%). side effects included: elevated of liver enzymes in four patients (2.43%), hypersensitive reaction in 2 patients (1.21%), leukopenia in 2 patients (1.21%), nausea in 1 patient (0.61%), skin tumor in 1 patient (0.61%), and t pancreatitis and hepatitis in one patient (0.61).Conclusionazathioprine reduced the rate of adverse effects and resolution of the ocular manifestations in patients with BS and has few side effects so, it is good choice to treat patients with BS.Keywords: Azathioprine, Behçet’s syndrome, Uveitis, Side Effects}
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Background and aims
Azathioprine (AZA) is an immunosuppressant medication that has toxicity to kidneys and liver. This study aimed to investigate the protective activity of carvacrol (CAR) against hepatorenal toxic activity of AZA in male Wistar rats.
MethodsAll study rats were divided into five groups: control (saline, ip); azathioprine-only (AZA 50 mg/kg, ip), Sily+AZA (Silymarin 50 mg/kg, gavage), CAR+AZA (CAR 10 mg/kg, gavage), and CAR+AZA (CAR 20 mg/kg, gavage) groups. Silymarin was used as the standard hepatoprotective drug. The drugs were administered once daily for 21 days in III-V groups, and a single dose of AZA was injected on the seventh day of the experiment.
ResultsAZA-intoxicated rats exhibited an elevation in aspartate transaminase (AST), alanine transaminase (ALT), and alkaline phosphatase (ALP) activity in serum, as well as an increase in extent of lipid peroxidation. Activities of enzymatic antioxidants (superoxide dismutase – SOD, catalase - CAT) in the serum, liver, and kidney were decreased as for the AZA group (P < 0.05). Co-treatment of CAR (both doses of 10 and 20 mg/kg) lowered the serum transaminases and ALP level, the elevation of endogenous enzymes levels, and the malondialdehyde (MDA) in serum and both tissues (P < 0.05). This protective effect was greater in CAR 10 compared to 20 mg/kg doses, which was comparable to silymarin.
ConclusionThis study demonstrated that the renal and nephrotoxic activities of AZA could be attributed to the generated increased oxidative stress, as well as to the CAR with antioxidant effect similar to that in silymarin, which protected these tissues against AZA-induced nephrotoxicity hepatotoxicity.
Keywords: Azathioprine, Carvacrol, Silymarin, Nephrotoxicity, Hepatotoxicity} -
Aplastic anemia is characterized by bone marrow failure and pancytopenia. It could be due to autoimmune disorders, radiation, drugs, or chemicals. Drugs that mostly cause aplastic anemia include chloramphenicol, non-steroidal anti-inflammatory drugs, antiepileptic drugs, gold salts, and antithyroid drugs. Clinical sign and symptoms often result from pancytopenia that includes signs of anemia and bleeding. In some patients, fever and sepsis are seen that are due to neutropenia. Azathioprine is a purine antimetabolite, an immunosuppressive drug that causes myelosuppression and pancytopenia, especially in patients who have some degrees of TPMT (Thiopurine Methyltransferase) activity. We present a patient who admitted to our hospital with fever and pancytopenia and a history of recent azathioprine treatment. Because of delay in the recovery of pancytopenia, she was suspected of aplastic anemia, and bone marrow aspiration and biopsy were done for her.Keywords: Aplastic anemia, Azathioprine, Pancytopenia}
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زمینه و هدفکولیت اولسراتیو یک بیماری روده ای التهابی ایدیوپاتیک و شایع در بالغین است. اگرچه کورتیکواستروئیدها از موثرترین درمان های نگهدارنده برای کولیت اوسراتیو هستند، ولی به دلیل وابستگی بیماران به اینگونه داروها و بروز عوارض جدی ناشی از این داروها، بکارگیری داروی سرکوب کننده سیستم ایمنی یا جراحی باید به طور جدی مورد توجه قرار گیرد. هدف از مطالعه حاضر، بررسی اثربخشی دوزهای کم داروی آزاتیوپرین در کاهش عود و وابستگی به کورتیکواستروئید در بیماران مبتلا به کولیت اولسراتیو بود.روش تحقیقدر این مطالعه توصیفی- تحلیلی از نوع مقطعی، تعداد 96 بیمار مبتلا به کولیت اولسراتیو به مدت یک سال پیگیری شدند. بیمارانی که براساس اندیکاسیون، تحت درمان با داروی کورتیکواستروئید قرار می گرفتند، در صورت عدم توانایی در کاهش دوز کورتیکواستروئید، در عود دوم تحت درمان با آزاتیوپرین با دوز mg/kg 1/5-1 قرار می گرفتند. مشخصات دموگرافیک، شدت بیماری در ابتدای مطالعه و پاسخ به درمان، عود بیماری و نیز عوارض دارویی در طی مطالعه مورد بررسی قرار گرفت. داده ها با استفاده ازآزمون Chi-square ، در نرم افزار SPSS تجزیه و تحلیل گردید.یافته هادر شروع مطالعه، بیش از 50 درصد بیماران دارای شدت بالای علائم بیماری بودند. در بیماران تحت مطالعه، 40 نفر (41/7%) وابستگی به کورتیکواستروئید داشتند که همه تحت درمان با داروی آزاتیوپرین قرار گرفتند. از 96 بیمار مورد پیگیری طی یک سال،24نفر عود بیماری داشته و 72 نفر عود نداشتند. 97/8 درصد بیماران وابسته به کورتیکواستروئید با تجویز آزاتیوپرین، کورتیکواستروئید را قطع کردند و فقط یک بیمار به دلیل عدم پاسخ به آزاتیوپرین، تحت عمل جراحی قرار گرفت.نتیجه گیریبا توجه به شیوع وابستگی به مصرف کورتیکواستروئیدها، تجویز دوزهای پایین آزاتیوپرین می تواند به عنوان یکی از درمان های موثر در کاهش میزان عود بیماری و نیز اجتناب از مصرف مکرر کورتیکواستروئید، مورد توجه بیشتر قرار گیرد.کلید واژگان: کولیت اولسراتیو, کورتیکواستروئید, آزاتیوپرین, عود بیماری}Background and AimUlcerative Colitis is an idiopathic inflammatory bowel disease that is common in adults. Although corticosteroids are the most effective preservative treatment for Ulcerative Colitis. However, due to the dependence of these drugs and their serious complications, the use of an immunosuppressive drug or surgery should be taken seriously. Thus the aim of the study was the evaluation of the efficiency of low doses of azathioprine (AZA) in reducing relapse and corticosteroid-dependence in Ulcerative colitis patients.Materials and MethodsIn this cross-sectional study, 96 patients with ulcerative colitis were followed for one year. Patients who indicated by corticosteroid therapy not able to reduce the dose of corticosteroid, at second relapse was treated with 1- 1.5 mg/kg of (AZA). Demographic characteristics, the severity of disease at the beginning of the study and response to treatment, recurrence of the disease, and drug side effects during the study. Data were analyzed using the Chi-square test in SPSS software.ResultsAt the beginning of the study, over 50% of patients had high symptoms of the disease. In the patients under study, 40 (41.7%) patients had corticosteroid dependence, all of them being treated with (AZA). Of the 96 patients during the one-year follow-up 24 patients are relapses and 72 patients did not have relapses. 97.8% of corticosteroid patients with (AZA)prescription, Corticosteroid was discontinued and only one patient did not response to AZA and was underwent surgery.ConclusionGiven the prevalence of use of corticosteroids, prescription of low doses of (AZA) can be considered as one of the effective therapies to reduce the rate of relapse of the disease and to avoid frequent use of corticosteroids.Keywords: Ulcerative Colitis, Corticosteroid, Azathioprine, Relapse of the Disease}
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Background and PurposeRhinocerebral mucormycosis is a rare fatal fungal infection which is on a growing trend, particularly among immunocompromised patients. Immunosuppressive drugs, including corticosteroids and antimetabolites, increase the risk of this infection. Herein, we reported the case of fulminant rhinocerebral mucormycosis in a patient with ulcerative colitis receiving azathioprine and corticosteroid.Case reportA 58-year-old woman was admitted to the hospital in a state of coma with an extensive necrosis in her nose. She was afflicted with intestinal bleeding after 1 month of fasting and was treated with azathioprine and a high dose of prednisolone for ulcerative colitis 2 months prior to hospital admission. The direct microscopic examination of the necrotic tissues of the paranasal sinuses showed several non-septate hyphae consistent with Mucorales. Culture media yielded Rhizopus species, which was identified as Rhizopus oryzae by internal transcribed spacer polymerase chain reaction sequencing. Despite the implementation of surgical and pharmaceutical (liposomal amphotericin B) treatments, the patient expired after 2 weeks of admission.ConclusionThe gastroenterologists should be aware of the adverse effect of immunosuppressive drugs they prescribe for the treatment of inflammatory bowel disease.Keywords: Azathioprine, Corticosteroid, Inflammatory bowel disease, Mucormycosis, Rhinocerebral, Ulcerative colitis}
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زمینه و هدفآزاتیوپرین دارویی با کاربرد وسیع در درمان بیماری های خودایمنی است که بر عملکرد و ساختار بافتی کلیه دارای اثرات منفی میباشد. لذا با توجه به اثرات محافظتی زنجبیل در برابر نفروتوکسینهای مختلف مطالعه حاضر با هدف بررسی اثر عصاره زنجبیل بر تغییرات کلیوی ناشی از مصرف آزاتیوپرین در موشهای صحرایی صورت گرفت.روش کاردر این مطالعه تجربی از 56 سرموش صحرایی ماده بالغ که به 7 گروه شامل کنترل، شاهد و 5 دسته تجربی دریافت کننده آزاتیوپرین (mg/kg50)، زنجبیل mg/kg 200، آزاتیوپرین به همراه زنجبیل با دوزهای mg/kg 200 و 100،50 تقسیم شدند. در این بررسی زنجبیل به صورت گاواژ و آزاتیوپرین به صورت درون صفاقی و برای مدت 21 روز تجویزشدند. در پایان سطح سرمی اوره، اسید اوریک و کراتینین اندازه گیری و ساختاربافتی کلیه های حیوانات بررسی گردید. نتایج از طریق آزمونهای ANOVA و دانکن در سطح معناداری 0/05 ≤ pآنالیز شدند.یافته هانتایج نشان داد آزاتیوپرین باعث تخریب ساختار بافتی همراه با نکروزه شدن سلولی، تخریب توبولی، کوچک شدن گلومرولها، بزرگ شدن فضای ادراری، پرخونی و ارتشاح سلولهای آماسی در بافت کلیه و همچنین افزایش سطح سرمی اوره و اسیداوریک وکراتینین در سطح 0/05 ≤ pمیشود، در حالیکه مصرف همزمان زنجبیل با آزاتیوپرین باعث کاهش معنادار میزان سرمی اوره، اسیداوریک وکراتینین و بهبود ساختاربافتی کلیه در مقایسه با گروه آزاتیوپرین میگردد.نتیجه گیریداده های این مطالعه نشان دادکه زنجبیل به واسطه خواص آنتی اکسیدانی خود توانسته با مهار رادیکالهای آزاد تولید شده توسط آزاتیوپرین، بر بافت کلیه اثر محافظتی داشته باشد واز شدت آثار تخریبی آزاتیوپرین بر بافت و عملکرد کلیه ها بکاهد.کلید واژگان: آزاتیوپرین, کراتینین, اسیداوریک, اوره, کلیه, موش صحرایی}Background and ObjectivesAzathioprine is widely used for the treatment of autoimmune diseases. It has negative effects on the function of kidney. Therefore, considering the protective effects of ginger on nephrotoxins, the present study was conducted to investigate the effect of ginger on renal changes induced by azathioprine in rats.MethodsIn this experimental study, 56 female rats were divided into 7 groups including control, sham and 5 experimental groups receiving azathioprine (50mg/kg), ginger (200mg/kg), azathioprine plus ginger (200,100 and 50 mg/kg). In this study, ginger was administered by gavage and azathioprine intraperitoneally in 21 consecutive days. At the end, serum levels of urea, uric acid and creatinine were measured and the histological structure of the kidneys was examined. The results were analyzed by ANOVA and Duncan tests at significance level of p≤0.05.ResultsThe results showed that azathioprine caused the destruction of structure along with cell necrosis, tubular degeneration, glomerular atrophy, urinary space enlargement, hyperemia and inflammatory cell infiltration in the renal tissue, as well as an increase in the serum level of urea, uric acid and creatinine at p≤0.05. However, simultaneous use of ginger and azathioprine reduced the serum levels of urea, uric acid, creatinine and improved the kidney structure compared to the azathioprine group.ConclusionThe results showed that ginger had a protective effect on kidney tissue, due to its antioxidant properties, by inhibiting free radicals produced by azathioprine and decreasing the severity degradation effects of azathioprine on kidney tissue and function.Keywords: Azathioprine, Uric Acid, Creatinine, Kidney, Urea, Rat}
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Skin manifestations can herald, co-exist, or follow the evolution of inflammatory bowel disease (IBD). We report a middle-aged man with recent onset alopecia universalis and a history of intermittent diarrheal attacks for 6 years. Colonscopy and biopsy sampling confirmed ulcerative colitis. Regrowth of hair was achieved by treating the patient with azathioprine and mesalamine. Clinicians have to be aware that a multitude of skin manifestations with history of diarrhea can be an extraintestinal manifestation of IBD such as ulcerative colitis and this warrants further investigation.Keywords: Ulcerative colitis, Alopecia universalis, Azathioprine}
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Aim: The aim of this study was to review our experience with gestations in autoimmune hepatitis patients.BackgroundThere are only limited data describing pregnancy in patients with autoimmune hepatitis.
Patients andMethodsRetrospective analysis of pregnancies with autoimmune hepatitis followed in Centro Hospitalar do Porto, Portugal in the last ten years.ResultsWe reported nine pregnancies in seven patients with autoimmune hepatitis. Two patients had documented liver cirrhosis prior to the pregnancy. In this study, 66.7% of patients were treated with azathioprine and 88.9% with prednisolone. Clinical improvements were observed in 11.1% of pregnancies and 22.2% exacerbations were diagnosed. There were six live births and two preterm deliveries (preterm delivery rate of 33%). We also report three first trimester miscarriages (early gestation miscarriage rate of 33%). There were no neonatal or maternal deaths.ConclusionThe favorable obstetric outcome is a realistic expectation in patients with autoimmune hepatitis. Tight monitoring and control of asymptomatic and unpredictable exacerbations, which are unrelated to the severity of the underlying disease, are essential to the prognosis of the current pregnancy.Keywords: high, risk pregnancy, liver disorder, pregnancy, azathioprine} -
Crohn’s disease (CD) is rarely presented with lower GI bleeding (LGIB) which eludes the clinician. A 25-year-old lady with severe rectorrhagia was presented with no history of constipation, diarrhea or abdominal pain. Colonoscopy revealed ulcers in the rectum, sigmoid colon, and terminal ileum. Crohn’s pathologic features were detected in the terminal ileum. The bleeding was controlled via supportive care and IV corticosteroid. Recurrent LGIB was managed by prednisolone and azathioprine. The patient had an uneventful recovery. The clinicians should consider CD as a possible diagnosis in severe LGIB. Prednisolone and azathioprine efficiently control acute bleeding episodes and prevent the recurrence.Keywords: Crohn's disease, Inflammatory bowel disease, Severe hemorrhage, Azathioprine, Corticosteroids, Rectosigmoidoscopy}
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Background
Atopic dermatitis is a chronic skin disease with increasing prevalence worldwide and a considerable burden especially among children. To circumvent the problems related to oral azathioprine (AZT) we aimed to evaluate its topical variant and assess its efficacy in patients aged 2-18.
Materials and MethodsIn a single-blind trial, we randomized the patients into two groups, one treated with topical emollient containing AZT and betamethasone (BM), and the other treated solely with topical emollient of BM. The treatments were administered twice a day for 8 weeks in both groups. The efficacy, recurrence, and the presence of side effects were evaluated using SPSS 20.
ResultsThe amount of reduction in severity scoring for atopic dermatitis (SCORAD) score was significantly greater in the group treated with the topical AZT (P = 0.024). Incidentally, there were no difference between two treatments in difference in proportions of recurrence and adverse effects as well as SCORAD reduction in subgroups of sex and age (all P > 0.05).
ConclusionsOur results showed the superiority of topical AZT over BM with a low recurrence and adverse effects. No expectation of severe side effects, like those of oral AZT, is the major advantage of topical AZT. The sample size was an issue in uncovering the value of AZT in the subgroups. Conducting prolonged studies of quality-of-life and comparing the topical AZT potency relative to the common alternatives are recommended areas of future work.
Keywords: Atopic, azathioprine, child, clinical trial, dermatitis} -
For the past half century, thiopurines have earned themselves a reputation as effective anti-cancer and immunosuppressive drugs. Thiopurine S-methyltransferase (TPMT) is involved in the metabolism of all thiopurines and is one of the main enzymes that inactivates mercaptopurine. 6-MP is now used as a combination therapies for maintenance therapy of children with acute lymphocytic leukemia (ALL). In all patients receiving mercaptopurine, there is a risk of bone marrow suppression.TPMT activity is inherited as a monogenic, co-dominant trait. More than 25 variants are known. Genetic testing is available for several TPMT variant alleles. Most commonly TPMT*2, *3A, and *3C are tested for, which account for >90% of inactivating alleles. Differences in DNA that alter the expression or function of proteins that are targeted by drugs can contribute significantly to variation in the responses of individuals.Genotyping may become part of routine investigations to help clinicians tailor drug treatment effectively. This success is mainly due to the development of combination therapies and stratification of patients according to risk of treatment failure and relapse, rather than the discovery of new drugs. The aim of this study was to investigate the effect of genotype or methyltransferase enzyme activity before starting therapy in children with ALL. This can prevent the side effect of thiopurine drugs. In fact, the common polymorphism of this enzyme in population could be a prognostic factor in relation to drug use and treatment of patients with ALL.Keywords: Acute lymphoblastic leukemia, Azathioprine, 6, Mercaptopurine, 6, Thioguanine, Myelosuppression, Polymorphism}
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BackgroundErythrocyte sedimentation rate (ESR) is one of the predictors of improvement in handling rheumatoid arthritis. This study was designed to define and compare the time of achieving normal ESR and also the percentage for the normalization of this marker at several points of time in two different combination therapies.MethodsFifty-two rheumatoid arthritis patients randomly received methotrexate, chloroquine, prednisolone (MCP) or azathioprine, chloroquine, prednisolone (ACP) and all were followed up for 34 weeks. Chloroquine and azathioprine were given, 150 mg/d and 2 mg/kg/d, respectively. Methotrexate was given, 0.2 mg/kg/week and simultaneously increased 2.5 mg monthly if no clinical response was seen. Prednisolone was started, 0.3 mg/kg/d and tapered after one week. ESR at baseline and during follow-up were checked. The data were collected and analyzed. This clinical trial was registered in the Iranian Registry of Clinical Trials (www.irct.ir) with registration number ID: 2012110611383N1.ResultsThe percentages of obtaining normal ESR after 2nd, 4th, 6th, 8th, 18th, 34th weeks of follow up were 42.4%, 53.9%, 57.7%, 65.4%, 88.5%, 96.2% in the MCP group and 47.9%, 65.3%, 74%, 78.3%, 82.7%, 87% in the ACP group. The mean time of obtaining normal ESR was 9.15 (95%CI, 5.58 to 12.73) weeks in MCP group and 9.04 (4.04 to 14.05) weeks in the ACP group (p>0.05).ConclusionThe results show that the time to achieve normal ESR and percentage of its normalization were almost the same in both treated groups.Keywords: Rheumatoid arthritis, Inflammation, Methotrexate, Azathioprine, Prednisolone}
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تعیین فعالیت آنزیم تیوپورین متیل ترانسفراز و رابطه آن با پاسخ به درمان در مبتلایان به پمفیگوس ولگاریس تحت درمان با آزاتیوپرینزمینه و هدف
آزاتیوپرین متداول ترین آد جوان مورد استفاده در درمان پمفیگوس ولگاریس است. آنزیم تیوپورین متیل ترنسفراز (TPMT) یکی از آنزیم های اصلی متابولیز کننده این دارو است که سطح فعالیت آن در هر فرد وسیله پلی مورفیسم ژنی شناخته و تعیین می شود و می تواند از نظر تئوری بر اثر بخشی و عوارض آزاتیوپرین تاثیر گذار باشد. هدف این مطالعه تعیین فعالیت آنزیم TPMT و عوامل همراه آن در مبتلایان به پمفیگوس ولگاریس تحت درمان با آزاتیوپرین بود.
روش اجرادر این مطالعه مقطعی، سطح فعالیت آنزیم TPMT در 52 بیمار مبتلا به پمفیگوس ولگاریس مراجعه کننده به بیمارستان رازی اندازه گیری شد که برای درمان، حداقل مدت 12 ماه آزاتیوپرین دریافت کرده بودند. در یک پرسش نامه نشانه های دموگرافیک و نیز نشانه های مربوط به وضعیت پاسخ دهی به آزاتیوپرین و عوارض مرتبط با این دارو با توجه به پرونده بیماران ثبت شد. سطح فعالیت آنزیم در 29 بیمار مبتلا به پمفیگوس ولگاریس که آزاتیوپرین دریافت نکرده بودند نیز اندازه گیری شد.
یافته هامیانگین سطح فعالیت آنزیم TPMT در بیمارانی که به درمان با آزاتیوپرین پاسخ مطلوب یا نامطلوب داشتند تفاوت معنی داری نداشت (P=0.087). طی یک سال بین دوز مجموع پرد نیزولون و سطح فعالیت آنزیم TPMT همبستگی مشاهده نشد. (،(p=0.583، r=0.089 بین سطح فعالیت آنزیم در بیمارانی که آزاتیوپرین دریافت کرده یا نکرده بودند تفاوت معنی داری وجود نداشت (p=0.36).
نتیجه گیریهر چند اندازه گیری آنزیم TPMT در پیش بینی مهار استخوان در بیمارانی که سطح فعالیت پایین یا غیرقابل اندازه گیری دارند ارزشمند است، ولی در مورد پیش بینی اثر بخشی درمان و تعیین دوز آزاتیوپرین بر اساس سطح فعالیت آنزیم نمی توان ادعایی داشت. شاید مطالعه های آینده نگر با گروه بیماران همگون تر بتواند این یافته تئوری را از نظر بالینی به اثبات برساند.
کلید واژگان: آزاتیوپرین, پمفیگوس, تیوپورین متیل ترانسفراز, اثربخشی}The relation between Thiopurine Methyl Transferase activity and efficacy and side effects of Azathioprine in patients with Pemphigus VulgarisBackground and aimAzathioprine is the most widely used immunosuppressive agent as an adjunct to corticosteroids in the treatment of pemphigus vulgaris (PV). Thiopurine methyl transferase (TPMT) is a key enzyme in azathioprine metabolism and a genetic polymorphism controls its activity in human tissue. TPMT activity can provide a rational basis to determine suitable dose of azathioprine, theoretically. The aim of this study was to evaluate the clinical relevancy of this hypothesis in PV patients.
Materials and MethodsIn this cross sectional study in Razi Hospital, the activity of TPMT in the red blood cells of 52 PV patients who received azathioprine for at least 12 months and 29 PV patients who did not receive this drug was measured and correlated to the clinical response and side effects observed.
ResultsThe mean of TPMT activity was not significantly different in patients with unfavourable response, comparing to patients with favorable response to azathioprine (P=0.087). No relationship was observed between total dose of corticosteroid and TPMT activity (r=0.089, P=0.583). There was no difference between the mean of TPMT activity in patients receiving azathioprine and those not receiving this drug (P=0.36).
ConclusionA direct relationship was not observed between TPMT activity and clinical efficacy and side effects in PV patients under treatment with azathioprine. Larger prospective studies in more homogenous patients are needed to evaluate the clinical relevance of TPMT polymorphism and to determine accurate azathioprine dosing guidelines based on TPMT activity.
Keywords: Azathioprine, Pemphigus, Thiopurine methyl transferase, Efficacy} -
زمینه و هدفاثرات درمانی آزاتیوپرین (AZA) و داکسی سیکلین (DOX) در بیماران آرتریت روماتوئید(RA) شناخته شده است. اما در مورد تفاوت اثرات این دو دارو با یکدیگر در درمان آرتریت روماتوئید اطلاعات زیادی در دست نیست. هدف این مطالعه مقایسه این دو دارو در درمان آرتریت روماتوئید است.مواد و روش کار71 بیمار دچار آرتریت روماتوئید فعال واجد شرایط در این کارآزمائی بالینی دو سوکور وارد شده و در دو گروه شامل 32 نفر در گروه آزاتیوپرین و 39 نفر در گروه داکسی سیکلین قرار گرفتند. طی مطالعه تمام بیماران مجاز به استفاده از پردنیزولون با دوز کمتر از 10 میلی گرم در روز بودند. گروه اول 100 میلی گرم آزاتیوپرین و گروه دوم 200 میلی گرم داکسی سیکلین در روز دریافت کردند. تمام بیماران در بدو ورود و سپس هر چهار هفته از نظر یافته های بالینی (تعداد مفاصل متورم، اندکس مفصلی ریتچی، مدت خشکی صبح گاهی، میزان درد و آزمون چنگ زدن) و متغیرهای آزمایشگاهی (هموگلوبین، پلاکت، لکوسیت، ESR، CRP و فاکتور روماتوئید) و ارزیابی کلی پزشک بررسی شدند.یافته ها71 بیمار (32 نفر در گروه آزاتیوپرین و 39 نفر در گروه داکسی سیکلین) مطالعه را به پایان رساندند. خصوصیات دموگرافیک، بالینی و پایه در دو گروه مشابه بود. در هر گروه پاسخ درمانی از نظر متغیرهای بالینی و آزمایشگاهی ذکر شده در بالا نسبت به مقادیر پایه در هفته شانزدهم از نظر آماری معنی دار بود. در مقایسه بین دو گروه جز در میزان ESR)001/0(P< وCRP)01/0(P< که در گروه آزاتیوپرین بهبودی بیشتری داشت، در سایر متغیرهای بالینی و آزمایشگاهی اختلاف معنی دار نبود) 05/0(P<. مقایسه ارزیابی کلی پزشک در دو گروه تفاوت مهمی از نظر بالینی نشان نداد. عوارض جانبی در گروه داکسی سیکلین مختصری بیشتر بود ولی عوارض وخیم منجر به خروج از مطالعه (دو نفر در گروه آزاتیوپرین به علت نوتروپنی شدید و یک نفر در گروه داکسی سیکلین به علت تهوع و استفراغ شدید) از نظر آماری معنی دار نبود.نتیجه گیریاثرات درمانی داکسی سیکلین و آزاتیوپرین در بیماران آرتریت روماتوئید یکسان بود و اختلاف معنی داری در متغیرهای بالینی و آزمایشگاهی بهبودی بیماری و ارزیابی کلی پزشک از بیماری، بین دو دارو وجود نداشت اما عوارض جانبی در داکسی سیکلین بیشتر از آزاتیوپرین دیده شد.
کلید واژگان: آرتریت روماتوئید, آزاتیوپرین, داکسی سیکلین}BackgroundTherapeutic effects of Azathioprine (AZA) and Doxycycline (DOX) on arthritis Rheumatoid (RA) patients have been recognized. However, there is not much information available about the difference of their effects in the treatment of RA.Methods and Materials: Seventy-one patients finished 16 weeks of the study. (32 patient in AZA and 39patients in DOX group). All patients received less than 10 mg/day prednisolone. Group 1 and 2 received 50 mg AZA and 100mg DOX twice in day respectively. We evaluated clinical (tender & swollen joint counts, Ritchi articular index, morning stiffness, pain score (VAS), gripe strength) and laboratory measurements (hemoglobin, platelets counts, WBC, ESR, CRP, RF) and physician overall assessment.ResultsAt entry, demographic, clinical and laboratory measurements were similar in both groups. At 16th week both groups showed statistically significant improvement in clinical and laboratory measurements. There were no statistically significant differences between the treatment groups in clinical and laboratory variables (P<0.05) except for ESR and CRP that were better improvement in AZA group (P<0/001,P<0/01respectively). Minor adverse effects (Gastrointestinal, skin) were more frequent in DOX group, but withdrawals because of sever adverse effects were similar in both groups.ConclusionsTherapeutic effects of DOX and AZA on arthritis Rheumatoid patients were alike and there was no significant difference in clinical and laboratory variable of illness recovery as well as overall evaluation of the two drugs, but side effects of DOX were more than those of AZA.Keywords: Azathioprine, Doxycycline, Rheumatoid Arthritis} -
Cyclosporin and azathioprine are immunosuppressive drugs, used widely in kidney transplant patients. A significant association between immunosuppressive therapy and multiple warts was described several years ago. There are also some reports of sebaceous gland hyperplasia in kidney transplant patients receiving cyclosporin. We report herein a 57-year-old woman who developed multiple warts on her hands and feet, lower lid syringomas, sebaceous gland hyperplasia of forehead and multiple mucosal irritation fibromas on tongue after kidney transplantation and a long course of treatment with oral cyclosporin, azathioprine and prednisolone since 6 years ago.
Keywords: Cyclosporin, Azathioprine, Wart, Sebaceous gland hyperplasia, syringoma, Irritation fibroma, Kidney Transplantation}
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