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Azathioprine treatment in multiple sclerosis; pretreatment assessment of metaboliser status
  1. F J THOMAS,
  2. T A T HUGHES
  1. Department of Neurology, University Hospital of Wales, Cardiff, UK
  2. Department of Dermatology, Royal Gwent Hospital, Cardiff Road, Newport NP 20 2UB, UK
  1. Dr FJ Thomas
  1. A ANSTEY
  1. Department of Neurology, University Hospital of Wales, Cardiff, UK
  2. Department of Dermatology, Royal Gwent Hospital, Cardiff Road, Newport NP 20 2UB, UK
  1. Dr FJ Thomas

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Azathioprine is a cytotoxic immunosuppressant drug used widely in clinical neurology as an adjunct to steroid treatment for autoimmune and inflammatory conditions. As a result of the relatively high cost and modest benefit of the newly licensed immunomodulatory therapies in the treatment of multiple sclerosis there has been a resurgence of interest in the possible benefits of azathioprine. A meta-analysis in 1997 suggested that it was as effective as newer treatments in increasing the proportion of patients who remain free of relapse at 2 years.1

The mode of action of azathioprine at the immune cell level remains unclear. It is converted rapidly in vivo to 6-mercaptopurine, which is extensively metabolised along three competitive routes (table1).2 Methylation catalysed by thiopurine transferase (TPMT) leads to the production of 6-methyl mercaptopurine. …

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