Azathioprine: friend or foe?

Antiviral Potential of Azathioprine and Its Derivative 6- Mercaptopurine: A Narrative Literature Review

“…Polymorphisms in the ITPase gene may account for these non–TPMT-related adverse effects [ 63 ]. There, a strong role from AZA as a procarcinogenic drug has also been reported, both in organ transplant recipients and in other immune-mediated inflammatory diseases, particularly IBD [ 64 ]. Likewise, a mutational signature analysis on cutaneous squamous cell carcinoma (cSCC) primary tumors has revealed the presence of a novel signature, whose incidence correlates with chronic exposure to AZA increasing the risk for cutaneous malignancy in AZA-treated patients [ 65 ].…”

Skin cancer burden in lung transplant recipients: we need to do better!

“…Many LTRs also receive voriconazole for treatment or prevention of fungal lung infections. Like azathioprine, voriconazole is photosensitizing to UVA and contributes to carcinogenesis both directly and indirectly through mechanisms that include generation of reactive oxygen species.…”

Why is the high risk of skin cancer in organ transplant recipients declining?

“…[1][2][3][4] The decline in incidence of SCC and BCC in OTRs affects our understanding of the relationship between skin cancer and immunosuppressive drugs. 8,9 The increased risk of these cancer forms in OTRs has traditionally been linked to reduced immunological tumour surveillance from the immunosuppressive drugs. Both azathioprine and cyclosporin, however, have also been shown to have direct mutagenic or carcinogenic effects.…”

“…Both azathioprine and cyclosporin, however, have also been shown to have direct mutagenic or carcinogenic effects. 8,9 Mammalian targets of rapamycin inhibitors, a newer class of immunosuppressive drugs not used in the Irish cohort, 4 have been documented to reduce the short-term risk of SCC in kidney transplant recipients with a previous SCC. 10,11 Therefore, it may be more appropriate to talk about keratinocyte carcinoma in OTRs as being immunosuppressant induced rather than being immunosuppression induced, as both immunosuppression and direct carcinogenic effects may be involved.…”

“…The increased risk of these cancer forms in OTRs has traditionally been linked to reduced immunological tumour surveillance from the immunosuppressive drugs. Both azathioprine and cyclosporin, however, have also been shown to have direct mutagenic or carcinogenic effects . Mammalian targets of rapamycin inhibitors, a newer class of immunosuppressive drugs not used in the Irish cohort, have been documented to reduce the short‐term risk of SCC in kidney transplant recipients with a previous SCC .…”