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Title: | Characteristics of azathioprine use and cessation in a longitudinal lupus cohort. | Authors: | Hoi A. ;Morand, Eric ;Croyle L. | Monash Health Department(s): | Rheumatology | Institution: | (Croyle, Hoi, Morand) 1Centre for Inflammatory Diseases, Monash University School of Clinical Sciences, Monash Medical Centre, Melbourne, Australia | Issue Date: | 15-Feb-2016 | Copyright year: | 2015 | Publisher: | BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com) | Place of publication: | United Kingdom | Publication information: | Lupus Science and Medicine. 2 (1) (no pagination), 2015. Article Number: e000105. Date of Publication: 01 Jun 2015. | Abstract: | Objective: Guidelines for azathioprine (AZA) use in systemic lupus erythematosus (SLE), including indications for initiation and cessation, are lacking. Clinical decision-making could be improved if reasons for cessation of AZA treatment were standardised. Method(s): We determined the characteristics of AZA use in a cohort of patients with SLE and evaluated reasons for AZA cessation. Patients with SLE in a single centre had longitudinal recording of disease activity (Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI)-2k), laboratory investigations and treatment from 2007 to 2012. Result(s): Of 183 patients studied, 67 used AZA on at least one occasion. There was no significant difference between AZA users and non-users in age or American College of Rheumatology criteria. Compared with those not treated with AZA, patients treated with AZA had higher disease activity (time-adjusted mean SLEDAI 5.2 +/-0.3 vs 3.8+/-0.3, p=0.0028) and damage (Systemic Lupus International Collaborating Clinics (SLICC)-SDI 1.6+/-0.3 vs 1.2+/-0.1, p=0.0445), and were more likely to have a positive dsDNA (p=0.0130) and receive glucocorticoids (p<0.0001). AZA therapy was ceased in 30/67 (45%) patients. The predominant reasons for cessation were treatment de-escalation 14 (47%), treatment failure 12 (40%) and toxicity 3 (10%). AZA was switched to mycophenolate mofetil (MMF) in 9/12 (75%) of treatment failures, and this choice was strongly associated with active lupus nephritis. Conclusion(s): AZA toxicity was uncommon, and many patients ceased therapy in the context of treatment deescalation. However, the frequent development of active lupus nephritis requiring MMF suggests the need to distinguish refractoriness, under-treatment and nonadherence to AZA in patients with SLE. These findings suggest that future studies of AZA metabolite measurement could prove valuable in the management of SLE. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1136/lupus-2015-000105 | ISSN: | 2053-8790 (electronic) | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/41072 | Type: | Article | Subjects: | lupus erythematosus nephritis/co [Complication] lupus erythematosus nephritis/dt [Drug Therapy] major clinical study male priority journal SLEDAI *systemic lupus erythematosus/dt [Drug Therapy] systemic lupus erythematosus/dt [Drug Therapy] *azathioprine/ae [Adverse Drug Reaction] *azathioprine/dt [Drug Therapy] *azathioprine/to [Drug Toxicity] cyclophosphamide/dt [Drug Therapy] double stranded DNA antibody/ec [Endogenous Compound] glucocorticoid/dt [Drug Therapy] hydroxychloroquine/dt [Drug Therapy] methotrexate/dt [Drug Therapy] mycophenolate mofetil/dt [Drug Therapy] prednisolone/dt [Drug Therapy] rituximab/dt [Drug Therapy] musculoskeletal disease assessment adult article cohort analysis controlled study corticosteroid therapy drug substitution drug treatment failure *drug use drug withdrawal female human laboratory test leukopenia/si [Side Effect] longitudinal study human laboratory test leukopenia / side effect longitudinal study lupus erythematosus nephritis / complication / drug therapy major clinical study male musculoskeletal disease assessment priority journal cohort analysis *systemic lupus erythematosus / *drug therapy systemic lupus erythematosus / drug therapy Article adult SLEDAI controlled study corticosteroid therapy drug substitution drug treatment failure *drug use drug withdrawal female |
Type of Clinical Study or Trial: | Observational study (cohort, case-control, cross sectional or survey) |
Appears in Collections: | Articles |
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