Azathioprine therapy of ?autoimmune? diseases

Corley, Charles C.; Lessner, Howard E.; Larsen, William E.

doi:10.1016/0002-9343(66)90086-6

Cited by 157 publications

(37 citation statements)

References 15 publications

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“…In addition to HN2 [4,13,24,26,43], corticosteroids have been used in combination with other drugs (table IV); thioguanine [10,12], 6-mercaptopurine [31,45], azathioprine [2,8,12,22,29,32,35,46,47,50], cyclophospha mide [5,9,22,48,51], methotrexate [9], thiomycetin [49] or chlorambucil [4,22]. Bariety et al [4] deliberately used LDS with a combination of an alkalyting agent (HN2 or chlorambucil) and an antimetabolite (cyclophosphamide or 6-mercaptopurine).…”

Section: Discussionmentioning

confidence: 99%

The Effect of Treatment with Prednisone and Nitrogen Mustard on the Renal Lesions and Life Span of Patients with Lupus Glomerulonephritis

Dillard¹,

Dujovne²,

Pollak³

et al. 1973

Nephron

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In 17 patients, active (diffuse) lupus glomerulonephritis was treated with a combination of mechlorethamine (HN₂) and a high dose of corticosteroids (HDS). Serial clinical and sequential histologic observations were made. The results were compared with those from a previously reported and comparable group of patients who were treated with HDS alone. The mortality rate seen in the more severely affected patients was similar in both groups and there was no significant difference in estimated survival. By contrast, in those in whom the kidneys were less severely affected, the estimated survival appeared to be better in those treated with HDS-HN₂. Control of histologic activity also occurred more rapidly in the HDS-HN₂ group.

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Section: Discussionmentioning

confidence: 99%

The Effect of Treatment with Prednisone and Nitrogen Mustard on the Renal Lesions and Life Span of Patients with Lupus Glomerulonephritis

Dillard¹,

Dujovne²,

Pollak³

et al. 1973

Nephron

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“…Immunosuppressive treatment was often recommended as preferred secondline treatment because response rates of 40% to 60% have been claimed in earlier reviews. 9,10,61 There is no doubt that immunosuppressive treatment is effective in some cases, but there is doubt on the overall efficacy. The opinion that cyclophosphamide is highly effective appears to be based on data from 2 earlier articles.…”

Section: General Remarksmentioning

confidence: 99%

How I treat autoimmune hemolytic anemias in adults

Lechner

Jäger

2010

Blood

279

246

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Autoimmune hemolytic anemia is a heterogeneous disease with respect to the type of the antibody involved and the absence or presence of an underlying condition. Treatment decisions should be based on careful diagnostic evaluation. Primary warm antibody autoimmune hemolytic anemias respond well to steroids, but most patients remain steroid-dependent, and many require second-line treatment. Currently, splenectomy can be regarded as the most effective and best-evaluated second-line therapy, but there are still only limited data on longterm efficacy and adverse effects. The monoclonal anti-CD20 antibody rituximab is another second-line therapy with documented short-term efficacy, but there is limited information on long-term efficacy and side effects. The efficacy of immunosuppressants is poorly evaluated. Primary cold antibody autoimmune hemolytic anemias respond well to rituximab but are resistant to steroids and splenectomy. The most common causes of secondary autoimmune hemolytic anemias are malignancies, immune diseases, or drugs. They may be treated in a way similar to primary autoimmune hemolytic anemias, by immunosuppressants or by treatment of the underlying disease. IntroductionAutoimmune hemolytic anemia (AIHA) is a rare disease. In a recent population-based study 1 the incidence was 0.8/100 000/year, but the prevalence is 17/100 000. 2 Primary (idiopathic) AIHA is less frequent than secondary AIHA. Secondary cases are often challenging because not only AIHA but also the underlying disease(s) must be diagnosed and treated. AIHA is essentially diagnosed in the laboratory, and considerable improvement has been made in this field. However, progress in treatment has been much slower. [3][4][5][6][7][8] Therapy has been reviewed by several investigators, [8][9][10][11][12][13][14][15] but no treatment guidelines have yet been published. DiagnosisThe diagnosis of AIHA is usually straightforward and made on the basis of the following laboratory findings: normocytic or macrocytic anemia, reticulocytosis, low serum haptoglobin levels, elevated lactate dehydrogenase (LDH) level, increased indirect bilirubin level, and a positive direct antiglobulin test with a broad-spectrum antibody against immunoglobulin and complement ( Figure 1). However, there are pitfalls, particularly in secondary cases, because not always are all of the typical laboratory findings of AIHA present. 15 Two pieces of information are of utmost importance for the clinician to make an appropriate treatment decision: (1) What type of the antibody is involved? (2) Is the AIHA primary or secondary? The type of antibody can be identified with the use of monospecific antibodies to immunoglobulin G (IgG) and C3d. When the red cells are coated with IgG or IgG plus C3d, the antibody is usually a warm antibody (warm antibody AIHA [WAIHA]). When the red cells are coated with C3d only, the antibody is often but not always a cold antibody. For definite diagnosis of a cold antibody AIHA (CAIHA), the cold agglutinin titer should be markedly elevated (Ͼ 1:512)...

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“…As antimetabolites have been reported to have a salubrious effect in patients with SLE [2,6,7,9,14,16,40] as well as in a variety of other 'auto immune' diseases [2,6,7,14,16,25,26,36,39] and have proven effective in preventing or minimizing damage in transplanted kidneys [5,13,35], it seemed reasonable to us, as it has to others [16,30,33,40], to use azathioprine in the treatment of a group of patients with active proliferative glomerulo nephritis due to SLE.…”

mentioning

confidence: 99%

Comparison of Azathioprine, Prednisone, and Heparin Alone or Combined in Treating Lupus nephritis

Cade

Spooner

Schlein

et al. 1973

Nephron

139

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50 patients with proliferative glomerulonephritis due to lupus erythematosus were assigned in order of their chronologic appearance at the hospital alternately to treatment with either daily high dose prednisone, azathioprine, prednisone and azathioprine combined, or combined azathioprine and heparin. Prednisone alone was ineffective both from a standpoint of maintaining kidney function or from preserving a state of well being. Only 2 of 15 patients treated with prednisone are doing well with an average survival for the group of 19 months. Azathioprine, alone, appeared very effective with 9 of 13 patients alive and doing well with an average survival of 38 months. Combinations of either azathioprine and prednisone or azathioprine and heparin were most successful, only 2 of 13 in each group died of renal failure. Complications of prednisone administra’ion were high both when prednisone was given alone or in combination with azathioprine.

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Azathioprine therapy of ?autoimmune? diseases

Cited by 157 publications

References 15 publications

The Effect of Treatment with Prednisone and Nitrogen Mustard on the Renal Lesions and Life Span of Patients with Lupus Glomerulonephritis

The Effect of Treatment with Prednisone and Nitrogen Mustard on the Renal Lesions and Life Span of Patients with Lupus Glomerulonephritis

How I treat autoimmune hemolytic anemias in adults

Comparison of Azathioprine, Prednisone, and Heparin Alone or Combined in Treating Lupus nephritis

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