You may be started on a low dose which is then increased gradually. Usual doses are: Azathioprine - between 1. Mercaptopurine - between 0. Doses are also based on the levels of certain enzymes in your body that break down the medicines. Your doctor may alter your dose of azathioprine or mercaptopurine later. If azathioprine or mercaptopurine make you feel better, you should be able to keep taking the medicine for some years.
Generally after four years, you and your IBD team will make a decision about whether to continue the medicine. Some people can continue to take the medicine for many years longer. Talk to your IBD team if you would like to think about stopping treatment.
Biologic Medicines Azathioprine is sometimes given together with biologic medicines such as infliximab or adalimumab. This can be more effective at bringing on and maintaining remission than taking biologic medicines alone. This combination may also reduce the likelihood of anti-drug antibodies being produced against these biological medicines, which can reduce how effective they are. But the risk of infection can be higher when azathioprine and biological medicines are used together. Allopurinol Allopurinol is a medicine that is usually used to treat gout, a type of arthritis.
But it also changes how azathioprine is broken down and increases the levels of medicine in the bloodstream. Sometimes when azathioprine is broken down by the body, it can release products that harm the liver.
This happens with 1 in 5 people. Your doctor may suggest taking a low dose of azathioprine together with allopurinol, which will boost the levels of azathioprine. Before you start treatment your IBD team will check that this treatment is right for you.
Levels of the TPMT thiopurine methyl transferase. This can cause serious side such as suppressed bone marrow function. If you have low TPMT levels the dose of azathioprine or mercaptopurine can be reduced. Screening to check that you are immune to specific infections.
You may be screened for previous exposure to Epstein Barr virus which causes glandular fever, as people who have never had this virus are at an increased risk of lymphoma. Vaccinations You should have all the vaccinations you need before you start treatment. These medicines can reduce normal bone marrow function causing changes in the blood and occasionally liver complications. This may happen over time, so regular tests are important. Blood tests Azathioprine affects the way your body produces new blood cells.
These will include full blood count and liver function tests. Eventually tests are likely to be every three months. Because azathioprine and mercaptopurine affect the way your immune system works, you may be more likely to get infections.
Even a mild infection such as a cold or sore throat could develop into a more serious illness. Being immune suppressed can be a problem. I always make sure I wash my hands thoroughly and with antibacterial soap to try and prevent infection.
Live vaccines contain viruses that have been weakened, but not destroyed. People who are taking medicines which affect the immune system may not be able to produce antibodies quickly enough and risk becoming infected by the disease.
Live vaccines include oral polio, yellow fever, rubella German measles , BCG tuberculosis , chickenpox, MMR measles, mumps and rubella and shingles. However, you may be able to have the inactivated polio vaccine.
Flu vaccines given by injection are safe. The Department of Health recommends that everyone on medicines which suppress the immune system should have an annual flu vaccination.
But if anyone in your family or household is due to have a live vaccine, check with your IBD team whether you need to take any special precautions. When starting on azathioprine, I made sure I was up-to-date with my vaccinations. I had a pneumonia vaccine and I make sure I have a flu jab every year. Before you take any new medicines, check with your doctor, pharmacist or IBD team, because they may interact with azathioprine or mercaptopurine and cause unexpected side effects.
This also applies to over-the-counter medicines and herbal, complementary or alternative medicines and treatments. You should also always tell anyone else treating you that you are taking azathioprine or mercaptopurine.
Tell your doctor if you become or are thinking of becoming pregnant while you or your partner are taking azathioprine or mercaptopurine. Mothers The companies that make azathioprine and mercaptopurine say the medicines should only be taken when necessary during pregnancy or when trying to conceive, just to be safe. But studies have shown increased rates of anaemia low haemoglobin in babies born to mothers on these medicines, so a haemoglobin check for the baby may be considered.
The companies that make azathioprine and mercaptopurine say the medicines should only be taken when necessary during breastfeeding. However, azathioprine and mercaptopurine are generally considered safe for use by breastfeeding mothers. Although a low dose of the drug has been found in breast milk for four hours after taking the medication, so you could consider expressing and discarding milk during this time. Talk to your consultant if you want to breastfeed whilst taking these drugs. All medicines can cause unwanted side effects, although not everyone will get them.
Side effects occur in around 1 in 3 people taking azathioprine or mercaptopurine, and this can be at any time during treatment. Immediate reactions. Any medication can cause an allergic reaction. Tell your doctor immediately if you develop any of the following symptoms:.
Mercaptopurine , also called 6-MP, is known to stop cancer cells from growing. This drug is often used to treat leukemia. Mercaptopurine can reduce the production of white and red blood cells. Your physician will likely want to conduct regular blood tests to ensure there is no damage to your bone marrow. Methotrexate blocks cell metabolism, which causes cells to die.
However, methotrexate has side effects that include possible toxicity of the liver or bone marrow and, in rare cases, toxicity of the lungs. Less severe side effects include:. While taking immunomodulators, pay attention to any signs of infection, such as fever or chills.
Any time you are taking immunomodulators, be sure your doctor is testing your blood regularly for signs of damage to your bones and internal organs. Some immunomodulators may be fine to take during pregnancy, but you will need to discuss the pros and cons of starting a new medication with your doctor first.
Learn how certain chemotherapy drugs, including 6-MP, infliximab, and methotrexate, are used in the treatment of Crohn's disease. Hyperpyrexia, or a very high fever, can indicate an infection or some other serious condition.
It's a medical emergency, so seek medical care…. One study with participants compared the early use of azathioprine in patients with recently diagnosed Crohn's disease to a conventional management strategy. Two studies were rated as high quality. Three studies were rated as low quality. Six studies were rated as unclear quality due to a lack of information.
A pooled analysis of six studies participants suggests that azathioprine at daily doses of 1. A pooled analysis of two studies participants showed no difference in the proportion of patients who maintained remission between azathioprine 1. One small study 77 participants suggests that azathioprine 2.
One small study 36 participants found no difference in maintenance of remission rates at one year between combination therapy with azathioprine 2. One study participants failed to show any difference in time spent in remission between early azathioprine treatment and a conventional management strategy. An increased risk of side effects was seen in participants who received azathioprine. Some of these side effects such as leukopenia a reduction in the number of white cells in the blood were serious in nature.
Common side effects included pancreatitis inflammation of the pancreas , leukopenia, nausea, allergic reaction and infection.
The choice to use azathioprine or 6-mercaptopurine should be made after careful consideration of the risks and benefits of using these drugs. More research is needed to allow conclusions about the comparative effectiveness and side effects of azathioprine and 6-mercaptopurine compared to other maintenance therapies such as methotrexate.
Further research is needed to assess the effectiveness and side effects of the use of azathioprine with infliximab and other biologics and to determine the optimal management strategy for patients with inactive Crohn's disease. Low quality evidence suggests that AZA is more effective than placebo for maintenance of remission in Crohn's disease. Although AZA may be effective for maintenance of remission its use is limited by adverse effects.
Low quality evidence suggests that AZA may be superior to budesonide for maintenance of remission but because of small study size and high risk of bias, this result should be interpreted with caution. No conclusions can be drawn from the other active comparator studies because of low and very low quality evidence.
Adequately powered trials are needed to determine the comparative efficacy and safety of AZA and 6-MP compared to other active maintenance therapies. Further research is needed to assess the efficacy and safety of the use of AZA with infliximab and other biologics and to determine the optimal management strategy for patients with quiescent Crohn's disease. The therapeutic role of azathioprine AZA and 6-mercaptopurine 6-MP remains controversial due to their relatively slow onset of action and potential for adverse events.
An updated meta-analysis was performed to evaluate the efficacy of these agents for the maintenance of remission in quiescent Crohn's disease.
0コメント