PubMed · 10393009
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L Kappos. 1999-06-26. Multiple sclerosis trials.. https://doi.org/10.1016/s0140-6736(05)76289-9
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A 6-year-old female diagnosed with idiopathic opsoclonus-myoclonus syndrome at 22 months of age who failed to respond to treatment with adrenocorticotropic hormone (ACTH), IV gammaglobulin (IVIG), and azathioprine is presented. Because of marked and progressive deterioration in motor function and speech, this patient received a course of plasmapheresis with concomitant steroids and azathioprine. Within 1 week, marked improvements in motor function were noted. Eighteen months later, the patient ambulates, walks without support, and attends a regular school in the appropriate grade level.
OBJECTIVE: To identify the frequency of use and appropriate monitoring guidelines for the adverse effects of azathioprine and 6-mercaptopurine (6-MP) in the therapy of patients with inflammatory bowel disease (IBD). METHODS: Surveys were sent to all physician members of the Canadian Association of Gastroenterology. Physicians were asked to describe their monitoring practices for IBD patients receiving azathioprine or 6-MP. A systematic literature search was also performed using MEDLINE for articles published in English between 1966 and 1999 using the MeSH terms 'azathioprine', '6-mercaptopurine', 'inflammatory bowel disease' and 'drug monitoring'. RESULTS: Azathioprine and 6-MP were used to treat an average of 7% of patients - a surprisingly low number given the proven efficacy of these agents. All respondents reported monitoring complete blood counts (CBC), while liver enzyme and pancreatic enzyme levels were monitored by 62% and 29% of respondents, respectively. The most commonly reported initial CBC testing frequencies were weekly (42%), monthly (26%) and biweekly (23%). From the literature, it was determined that severe leukopenia (less than 2.10 g/L) occurs in less than 2% of cases and is sometimes associated with serious outcomes, including death. Most cases of severe leukopenia occurred abruptly, early in treatment. Other reported adverse effects and incidences were pancreatitis (3% to 5%), hepatotoxicity (less than 1%) and hypersensitivity (2% to 3%). Data concerning an increased risk of non-Hodgkin's lymphoma were equivocal. CONCLUSIONS: Use of azathioprine or 6-MP is low in patients with IBD. A CBC should be performed at weeks 1, 2, 4, 6, 8 and 12, with subsequent testing every eight weeks for the duration of azathioprine or 6-MP treatment. The evidence in support of pancreatic and hepatic monitoring is weak. The risk of non-Hodgkin's lymphoma is likely low.
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