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Azathioprine relieves symptoms of patients with chronic pruritus

Azathioprine treatment for patients with chronic pruritus provided substantial symptom relief, though many of the patients experienced adverse events, according to recently published study results.

Researchers studied 96 patients (57 female; mean age, 54.5 years) with systemic steroid-responsive pruritus with a mean symptom duration of 52.9 months who were treated with azathioprine, with a mean starting dose of 137.5 mg. Mean maximum dose was 171 mg.  Levels of 6-thioguanine, the active metabolite, and 6-methyl-mercaptopurine, the product of thiopurine methyltransferase, were monitored to make dosage adjustments in 52 patients.

Patients were treated with azathioprine for a mean duration of 15.91 months. The mean visual analogue scale itch score was 9.25/10 pretreatment, 1.625/10 posttreatment.

Sixty-two patients (64.6%) developed adverse events, including transaminitis, gastrointestinal upset, azathioprine hypersensitivity syndrome, myelosuppression, infection and pneumonia. Nine patients developed malignancy. Thirty-two patients (33.8%) permanently discontinued treatment and were switched to 6-thioguanine (three patients) or mycophenolate mofetil.

“Our results support azathioprine as a valuable treatment modality for patients with refractory, life-altering chronic pruritus,” the researchers concluded. “Knowledge of the associated risks is essential for both clinician and patient before initiating therapy. Further study is needed into potential treatment modalities among patients with intractable pruritus.” – By Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.