In CIDP, such drugs either showed no significant benefit or there

In CIDP, such drugs either showed no significant benefit or there were no efficacy data available from randomized controlled clinical trials. Azathioprine is a purine Ceritinib analogue that is metabolized rapidly to the cytotoxic

and immunosuppressant derivatives 6-mercaptopurine and thioinosinic acid. The latter inhibits purine synthesis, impairs activation and proliferation and causes apoptosis of T cells and B cells due to their lack of metabolic pathways for nucleotide salvage (‘recycling’). Azathioprine is used widely in organ transplantation and in autoimmune disorders. Azathioprine has been the most widely used immunosuppressive treatment in MS prior to approval of immunomodulatory therapies. Preparations and administration: azathioprine is usually administered orally at a dose of 2−3 mg/kg/day in two to three single doses. Clinical trials: in a recent meta-analysis of five controlled, randomized clinical trials involving 698 patients Z-VAD-FMK manufacturer with RRMS, azathioprine at a dose of 2−3 mg/kg/day reduced the relapse rate compared with placebo during the first year of treatment [relative risk reduction (RRR) = 20%], at 2 years’ (RRR = 23%) and at 3 years’ (RRR = 18%) follow-up [39]. Moreover, in three small trials with a total of 87 patients, azathioprine reduced

the number of patients with disability progression (RRR = 42%) at 3 years’ follow-up compared to placebo [39]. Unfortunately, data on MRI paramenters of inflammation or degeneration were not available [39]. CYTH4 In CIDP, azathioprine showed no significant benefit on primary (clinical disability) or secondary (electrophysiological parameters, demand for corticosteroids and/or IVIG) outcomes measures

in a recent meta-analysis that included only one controlled, randomized clinical trial with 27 patients [25]. Due to the limited size of the study, uncertainty remains about the effects of azathioprine and its use in patients with CIDP, in whom disease activity cannot otherwise be controlled. Adverse effects, frequent: gastrointestinal disturbances, bone marrow suppression and hepatic toxicity are the most frequent side effects. Infrequent: data from clinical trials and from cohort and case–control studies did not show an increase in risk of malignancy from azathioprine. However, a possible long-term risk of cancer from azathioprine may occur with treatment duration longer than 10 years or cumulative doses above 600 g [39]. In RRMS and CIDP, other ‘classic’ non-selective oral immunosuppressive drugs such as methotrexate, mycophenolate mofetil, tacrolimus/sirolimus and cyclosporin A (as monotherapies) either showed no significant benefit or there are no data available from randomized, controlled clinical trials to support a clinical benefit [25, 40]. Due to the loss of patent protection of these drugs, it is unlikely that new studies will be performed to support their use as monotherapies in MS and CIDP.

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