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Azathioprine safe, effective in treating pediatric atopic dermatitis

Azathioprine was effective in reducing disease severity and had few adverse effects among children with atopic dermatitis, according to study results.

Researchers analyzed 12 patients (median age at therapy, 9 years; eight females) with chronic, moderate to severe atopic dermatitis (AD) who were assigned oral azathioprine from October 2008 to May 2012. SCORing atopic dermatitis (SCORAD) index was used to determine disease severity (>40 considered severe), and patients’ SCORAD assessments ranged from 44 to 59. Thiopurine methyltransferase (TPMT) activity, metabolites 6-thioguanine nucleotide (6-TGN) and 6-methylmercaptopurine (6-MMP) were measured at baseline and during stable improvement, inadequate response or response change.

Eleven patients showed notable improvement with azathioprine therapy and saw decreases in mean SCORAD of 27.7 ± 8.7 upon stable improvement, just before drug tapering or at response plateau. There were few side effects, which were overall mild, and no patients discontinued treatment. TPMT activity was inversely correlated to clinical therapy response, with significant changes in levels for three patients. Two experienced a mild decrease and one increased TPMT activity from intermediate to normal range. 6-TGN and 6-MMP did not show an inverse correlation.

The study was limited by the number of patients, the researchers said.

“Our results suggest that TPMT activity can alter in either direction during treatment,” the study authors said. “Repeated measurement might be warranted, particularly in cases of nonresponse to treatment, to optimize dosing or to consider alternate therapy. In contrast, 6-TGN and 6-MMP … measurement does not appear to be helpful in AD treatment monitoring.”