Azathioprine Intolerance in Japanese Patients with Antineutrophil Cytoplasmic Antibody-associated Vasculitis

作者：Morishita Michiko; Watanabe Haruki; Yan Minglu; Zeggar Sonia; Hiramatsu Sumie; Ohashi Keiji; Miyawaki Yoshia; Katsuyama Eri; Katsuyama Takayuki; Narazaki Mariko Takano; Tatebe Noriko Toyota; Watanabe Katsue Sunahori; Kawabata Tomoko; Sada Ken Ei^*; Wada Jun

来源：Internal Medicine, 2017, 56(13): 1645-1650.

DOI：10.2169/internalmedicine.56.8287

• adverse events
• anti-neutrophil cytoplasmic antibody-associated vasculitis
• azathioprine

Objective To assess the safety of azathioprine (AZA) in Japanese patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV).
Methods We retrospectively enrolled 67 consecutive AAV patients who had initiated AZA treatment from January 2006 to August 2014 at Okayama University Hospital. We evaluated the development of severe adverse events (AEs), AZA discontinuation due to total AEs (severe AEs included) within 1 year, and AZA-associated risk factors.
Results The patients' median age was 70 years old. Forty-nine women and 18 men participated at the initiation of the study. Fifty-eight (87%) patients experienced AEs, and 36 experienced severe AEs (21 hepatic and 11 cytopenic severe AEs). Thirty-one (46%) patients discontinued treatment because of AEs. Abnormal hepatic laboratory test results at the treatment initiation were more frequent in patients with hepatic severe AEs and were associated with treatment discontinuation. The leukocyte and neutrophil counts at the treatment initiation were lower in the patients who discontinued treatment because of cytopenic AEs than in those who continued treatment. Only two patients experienced flare-ups during treatment.
Conclusion The AE-associated AZA discontinuation rate in Japanese AAV patients was relatively high. AZA use warrants caution in patients with abnormal hepatic laboratory test results or low leukocyte or neutrophil counts.

• 出版日期2017