Influence of methotrexate and azathioprine on radiologic progression in rheumatoid arthritis: a randomized, double-blind study

Article Abstract:

One measure of the severity of rheumatoid arthritis is the degree of joint and bone damage detected by X-rays, known as radiologic damage. The effectiveness of anti-arthritis drugs can be assessed by following the progression or retardation of radiologic damage. An evaluation of the effectiveness of two anti-arthritis drugs, azathioprine and methotrexate, was carried out by randomly assigning 64 patients to one of the two drugs and then following them for clinical effectiveness and radiologic damage for 48 weeks. The difference in response to the two drugs was impressive. In the azathioprine group, 13 patients had to be withdrawn because of severe side effects and 8 stopped the drug for lack of effect. In contrast, only two patients in the methotrexate group stopped treatment because of side effects, and four stopped for lack of effect. At the end of the 48 weeks, 90 percent of the remaining methotrexate patients had a good or partial overall improvement, compared with 70 percent of the azathioprine patients. The methotrexate group experienced much slower radiologic progression of their arthritis than the azathioprine group, as indicated by fewer new joint erosions and by better joint scores (measures of the extent of joint narrowing). However, no patients showed radiologic improvement. The study clearly demonstrated that methotrexate was the more efficacious drug in terms of clinical response and retardation of radiologic progression of rheumatoid arthritis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Rheumatoid arthritis, Methotrexate

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Azathioprine and 6-mercaptopurine in Crohn disease: a meta-analysis

Article Abstract:

The use of azathioprine and 6-mercaptopurine may have limited benefit for patients with Crohn's disease. Crohn's disease is a long-term disease causing inflammation in portions of the bowel. Researchers pooled data from 9 studies testing the effects of azathioprine and 6-mercaptopurine on patients with active Crohn's disease and on those in remission. Fifty-six percent of the patients with active disease responded to treatment compared to 32% of those taking placebo. Sixty-seven percent of the patients in remission responded to treatment while 53% taking placebo responded. For patients in remission, a higher dose seemed to improve the effect of the drug. Patients with active Crohn's disease seemed to benefit from a longer course of treatment (17 wks). Nearly 9% of the patients given these drugs reported adverse side effects. These side effects included allergic reactions, nausea, fever, low white blood cell count, and inflammation of the pancreas.

Crohn's disease, Mercaptopurine

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Chronic hepatitis with combined features of autoimmune chronic hepatitis and chronic hepatitis C: favorable response to prednisone and azathioprine

Article Abstract:

Patients with characteristics of both autoimmune hepatitis and chronic hepatitis C may respond well to prednisone and azathioprine therapy. Since therapies for each disease are incompatible, drug treatment guidelines are far from established. Researchers treated two female patients with these combined features by administering daily doses of prednisone and azathioprine. One 74-year-old woman received initial dosing of 30 milligrams (mg) of prednisone and 50 mg of azathioprine for eight months. She has remained healthy for three years while on maintenance therapy with 5 mg prednisone and 50 mg azathioprine. Liver biopsy detected minimal inflammation after treatment. Similarly, a 38-year-old woman with previous alcohol abuse continued prednisone/azathioprine therapy successfully and has been well for two years.

Hepatitis C, Prednisone, Chronic active hepatitis

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