Azathioprine

[pinkandfluffy]

Hello everyone,

Sorry I have an odd question. Im taking Aza. Am I correct when trying to explain my meds to people that I'm on a chemotherapy medication ?

Thank you

[PMRpro]

Yes, originally it was developed as a cancer drug:

"Azathioprine (AZA), also known by its brand name Imuran, is an immunosuppressive drug used in organ transplantation and autoimmune diseases and belongs to the chemical class of purine analogues. Synthesised originally as a cancer drug and a prodrug for mercaptopurine in 1957, it has been widely used as an immunosuppressant for more than 50 years."

but it is used for a lot of different things nowadays - anything where suppressing the activity of the immune system is important:

"Azathioprine is used alone or in combination with other immunosuppressive therapy to prevent rejection following organ transplantation, and to treat an array of autoimmune diseases, including rheumatoid arthritis, pemphigus, systemic lupus erythematosus, Behçet's disease, and other forms of vasculitis, autoimmune hepatitis, atopic dermatitis, myasthenia gravis, neuromyelitis optica (Devic's disease), restrictive lung disease, and others. It is also an important therapy and steroid-sparing agent for inflammatory bowel disease (such as Crohn's disease and ulcerative colitis) and for multiple sclerosis."

Technically, all treatment of disease with chemical substances is chemotherapy but it has become associated with the treatment of cancer by cytotoxic (kills living cells) and other drugs.

One of the things aza can do is "potentiate" the effect of prednisolone - it changes the way the body processes the pred and so you may get more effect from the same dose and you can manage on a lower dose, it is then called a "steroid sparer". It doesn't always work that way though but it is often combined with pred in the hope.

It's a perfectly reasonable way of describing your medication to others - then they get a bit of an idea how serious your illness is. But the doses used for different illnesses vary - doesn't stop it being a very powerful drug and the World Health Organisation classifies aza as one of the essential medicines for a basic healthcare system.

[pinkandfluffy in reply to PMRpro]

Wow

Thank you so much for your reply. I really appreciate it.

Very best wishes

[PMRpro in reply to pinkandfluffy]

My pleasure xxx

[MargaretGail in reply to PMRpro]

Hi PMPpro, so basically Aza is chemotherapy just because is it a chemical and not Chemo as we know it as a cancer treatment? Thanks Gail

[PMRpro in reply to MargaretGail]

Not sure I understand what you mean. The lay person tends to use the term chemotherapy just to mean drugs used in cancer treatment - but chemotherapy for a scientist means a chemical being used to have an effect on a disease. The term chemotherapy for cancer is used to distinguish between chemotherapy (killing/altering cells with chemicals) and radiotherapy (using ionising radiation to kill/alter cells). Nowadays we also have biologic therapies - with a totally different mechanism again and which can be used in cancers too, depending on how they act.

There are a lot of drugs which when used at high doses are used for chemotherapy but which are used for other things at far lower doses - methotrexate is another most of you will have heard of. Used at low doses it can prevent progression of RA for example. In high doses it will kill off cells as part of a chemotherapy.

[MargaretGail in reply to PMRpro]

Thanks for such informative replies x

[LesJames]

Such an informative reply, thank you. This has helped me tremendously in my quest to reduce my steroid dose.

[JL1w]

Thankyou for that very informative reply that has helped me too in understanding my medications . Do you know is cyclosporine the same as aza ?

Best wishes to you all xx

[PMRpro in reply to JL1w]

In what sense?

"Ciclosporin, also spelled cyclosporine, is an immunosuppressant drug widely used in organ transplantation to prevent rejection. It reduces the activity of the immune system by interfering with the activity and growth of T cells."

"Azathioprine, also known by its brand name Imuran, is an immunosuppressive drug used in organ transplantation and autoimmune diseases and belongs to the chemical class of purine analogues."

So in the sense they are both chemicals that suppress the immune system and are used in transplantation surgery - yes. But the mechanism by which they do it is totally different - aza works at the DNA level, cyclosporine has an effect via the T-cells but I don't think it is understood how.

In some diseases they might both work, in others one works, the other doesn't. It all depends on what actually causes the disease at the cellular level - and really, that applies for most diseases.

Sorry, can't explain any more than that.

[JL1w]

Wow !! such an informative reply thanks for taking the time .

Apparently my rheumy picked Cyclosporine as oppose to other immunosuppressant drugs as I also have early stage Multiple Myeloma cancer (diagnosed a year ago alongside SLE ,Sjogrens and hypothyroid so double whammy !!) he needed to protect my kidneys and he thought this would be the best one .... Obv this was way above my medical knowledge so I have had to leave that decision totally in his hands .I am very nervous about the potential side effects but I guess the long term plan is to get off steroids which can have awful long term side effects anyway ...I have now been taking Cyclo for 2 weeks and so far so good so fingers crossed !

You have excellent medical knowledge are you medically trained ? I am a nurse but still find it all very hard to absorb all the info and understand everything .

Thanks again and best wishes xx