Disease relevance of Imurel

• Reversible lymphoma in the setting of azathioprine therapy for Crohn's disease [1].
• Azathioprine decreases suppressor T cells in patients with multiple sclerosis [2].
• Azathioprine for long-term maintenance of remission in autoimmune hepatitis [3].
• We conducted a two-year randomized, placebo-controlled, double-blind trial of azathioprine (2.5 mg per kilogram of body weight per day) in Turkish men with Behçet's syndrome without eye disease (group 1; n = 25) or with eye disease (group 2; n = 48) [4].
• Two of these patients (both with pancytopenia) relapsed when the azathioprine was withdrawn; in the other two, remission was maintained with the resumption of prednisolone [3].
• NRH is a rare but potentially severe complication of azathioprine in patients with inflammatory bowel disease [5].

Psychiatry related information on Imurel

• Dementia developed in a renal transplant recipient who was receiving prednisone (15 mg per day) and azathioprine (50 mg per day) [6].
• Azathioprine-induced leukopenia was uncommon (19 episodes in the triple therapy group) [7].
• Mechanisms by which azathioprine and infliximab may impair the natural defense mechanisms against Pneumocystis are discussed [8].
• Antilymphocyte antiserum and azathioprine increased the mortality and shortened the latency period of leukemia [9].
• TPMT activity may be influenced by a mutation in the TPMT gene resulting in individual differences in azathioprine metabolism [10].

High impact information on Imurel

• METHODS: We administered daclizumab (1.0 mg per kilogram of body weight) or placebo intravenously before transplantation and once every other week afterward, for a total of five doses, to 260 patients receiving first cadaveric kidney grafts and immunosuppressive therapy with cyclosporine, azathioprine, and prednisone [11].
• With the higher dose of azathioprine, four patients had myelosuppression, defined as a decrease in the leukocyte and platelet counts to less than 4000 and 150,000 per cubic millimeter, respectively [3].
• Lymphopenia developed in 32 of 56 patients treated with 2 mg of azathioprine per kilogram per day for more than two years [3].
• We prospectively studied the magnitude, distribution, and mechanism of bone loss in 20 adults who received renal allografts from living related donors, who had good renal function, and who were treated with azathioprine, cyclosporine, and low doses of prednisone [12].
• There were fewer episodes of hypopyon uveitis (1 vs. 15; P less than 0.001) among the group 2 patients who took azathioprine [4].

Chemical compound and disease context of Imurel

• To evaluate the frequency and the pathogenesis of hyperuricemia and gout during cyclosporine therapy, we studied renal-transplant recipients who were treated with either cyclosporine and prednisone (n = 129) or azathioprine and prednisone (n = 168) [13].
• The successful treatment of autoimmune hepatitis with 6-mercaptopurine after failure with azathioprine [14].
• CONCLUSIONS: A loading dose does not decrease the time to response in patients with steroid-treated Crohn's disease beginning azathioprine therapy [15].
• CONCLUSIONS: While no difference was observed in the efficacy of azathioprine and mesalamine in preventing clinical and surgical relapses after conservative surgery, azathioprine is more effective in those patients who have undergone previous intestinal resection [16].
• Therefore, other immunosuppressive agents have been used to replace glucocorticoids in the long-term treatment of autoimmune hepatitis, including azathioprine, a purine analogue [14].

Biological context of Imurel

• The kinetics of the monocyte also changes under the low dosage of azathioprine [17].
• During treatment with 3 mg/kg azathioprine the cell cycle time of the promonocytes was on the average 5.5 h longer than in the normal steady state and the rate of monocyte production was reduced by 70% [17].
• On the basis of these results it can be concluded that azathioprine arrests the cell cycle of the promonocytes late in the DNA synthesis phase or in the postsynthesis (G2) phase and mitosis does not occur [17].
• We found that azathioprine and its metabolites induced apoptosis of T cells from patients with Crohn disease and control patients [18].
• 8 years after transplantation, patient survival was 75.3% in the cyclosporin group and 85.9% in the azathioprine group (p = 0.14) and graft survival was 64.0% and 76.6%, respectively (p = 0.38) [19].

Anatomical context of Imurel

• Azathioprine-induced pure red blood cell aplasia [20].
• The effect of azathioprine (Imuran) on the cell cycle of promonocytes and the production of monocytes in the bone marrow [17].
• The diminished mitotic activity of the promonocytes during azathioprine treatment depressed monocyte production [17].
• SLE patients treated with moderate or high dose corticosteroids or immunosuppressive agents (cytoxan or azathioprine) appeared to lose lymphocyte antigens detected by these reagents [21].
• Azathioprine treatment increases hepatocyte turnover [22].

Associations of Imurel with other chemical compounds

• Fifty-three renal transplant recipients with good to excellent renal function, while receiving daily maintenance or near-maintenance doses of azathioprine and methylprednisolone, were gradually converted to alternate-day corticosteroid therapy [23].
• Immunosuppression with a combination of cyclosporin, azathioprine, and prednisolone may be unsafe [24].
• The adjusted odds ratio for patients receiving 6-mercaptopurine/azathioprine for any and major infectious complications was 1.68 (95% CI, 0.65-4.27) and 1.20 (95% CI, 0.37-3.94), respectively [25].
• Conversion from cyclosporin to azathioprine after kidney transplantation [26].
• If treatment is episodic, maintenance therapy with immunosuppression (azathioprine [AZA]/6-mercaptopurine [6-MP] or methotrexate) is mandatory [27].
• In kidney transplantation, the long-term risk/benefit profile of MMF and azathioprine therapy in combination with cyclosporine Neoral is similar [28].

Gene context of Imurel

• The autosomal recessive trait of thiopurine S-methytransferase (TPMT) deficiency is associated with severe hematopoietic toxicity when patients are treated with standard doses of mercaptopurine, azathioprine, or thioguanine [29].
• Circulating soluble tumor necrosis factor receptors, interleukin-2 receptors, tumor necrosis factor alpha, and interleukin-6 levels in rheumatoid arthritis. Longitudinal evaluation during methotrexate and azathioprine therapy [30].
• Adverse drug reactions to azathioprine therapy are associated with polymorphism in the gene encoding inosine triphosphate pyrophosphatase (ITPase) [31].
• CONCLUSION: Steroids and azathioprine did not sufficiently suppress monokine responses, whereas MMF treatment might inhibit chronic graft rejection because of suppression of TNF-R1 expression and vigorous inhibition of monokine secretion [32].
• OBJECTIVE--To study the possible association of purine enzyme activities with response to azathioprine (AZA) treatment in rheumatoid arthritis (RA) and their correlation with parameters of disease activity [33].

Analytical, diagnostic and therapeutic context of Imurel

• We conclude that early immunosuppression with short-term use of corticosteroids plus daily azathioprine can improve metabolic control in some patients with insulin-dependent diabetes mellitus, but results from this unblinded study are preliminary and require further confirmation and long-term follow-up [34].
• The control group consisted of 15 heart-transplant recipients who were treated with azathioprine and who had also survived for at least 12 months [35].
• These findings explain the immunosuppressive effects of azathioprine and suggest that 6-Thio-GTP derivates may be useful as potent immunosuppressive agents in autoimmune diseases and organ transplantation [18].
• Although the optimal dose of steroids is still unknown, there seems little justification for continued use of high doses of oral steroids with azathioprine after cadaveric renal transplantation [36].
• The hypoglycaemia did not respond to plasmapheresis or azathioprine alone, but it remitted after the addition of prednisolone, and the erythrocyte receptor binding of insulin became normal [37].

References