Original articleOral azathioprine for recalcitrant pediatric atopic dermatitis: Clinical response and thiopurine monitoring
Section snippets
Methods
The study was approved by the University of California, San Diego, Institutional Review Board. Patients were aged 2 to 18 years with chronic, moderate to severe AD (objective SCORing AD [SCORAD] index ≥25 and meeting Hanifin and Rajka criteria) attending the pediatric dermatology clinic and Eczema Center at Rady Children's Hospital, San Diego, CA. Patients warranting systemic treatment because of repeated failure of topical anti-inflammatory and adjunctive therapies, with significant negative
Results
Patients' baseline severity (all severe with SCORAD >40) and treatment course are presented in Table I. Age of AD onset ranged from 1 to 24 months and the median age at starting azathioprine therapy was 9.0 years. All but patient 9 had significant improvement, with a decrease in SCORAD of 27.7 ± 8.7 (mean ± SD) at the time of stable improvement just before starting taper of drug or at response plateau. No patient discontinued treatment because of adverse events. Two experienced minor
Discussion
This study provides prospective, long-term data in 12 children to support the use of azathioprine for recalcitrant AD and assessed various parameters of drug monitoring during therapy.
TPMT is the best-studied enzyme involved in thiopurine drug metabolism and illustrates the use of pharmacogenomics in clinical practice. Previously, concern for myelosuppression led to initiation of treatment at very low doses, with slow upward titration and sometimes limited effect.7 The availability of a RBC
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Cited by (0)
Dr Tom is supported by a National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases research career development grant (K23AR060274).
The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Arthritis and Musculoskeletal and Skin Diseases or the National Institutes of Health.
Conflicts of interest: None declared.