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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(03): 229-232
DOI: 10.1590/0004-282X-ANP-2020-0041
Articles

Long-term safety of azathioprine for treatment of neuromyelitis optica spectrum disorders

Segurança a longo prazo da azatioprina no tratamento dos transtornos do espectro da neuromielite óptica
Ana Beatriz Ayroza Galvão Ribeiro GOMES 
1   Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil.
,
Milena Sales PITOMBEIRA 
1   Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil.
,
Douglas Kazutoshi SATO 
2   Pontifícia Universidade Católica do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre RS, Brazil.
,
Dagoberto CALLEGARO 
1   Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil.
,
Samira Luisa APÓSTOLOS-PEREIRA 
1   Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil.
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ABSTRACT

Background: Azathioprine is a common first-line therapy for neuromyelitis optica spectrum disorder (NMOSD). Objective: The aim of this study was to determine whether long-term treatment (>10 years) with azathioprine is safe in NMOSD. Methods: We conducted a retrospective medical record review of all patients at the School of Medicine of the University of São Paulo (São Paulo, Brazil) who fulfilled the 2015 international consensus diagnostic criteria for NMOSD and were treated with azathioprine for at least 10 years. Results: Out of 375 patients assessed for eligibility, 19 were included in this analysis. These patients’ median age was 44 years (range=28-61); they were mostly female (17/19) and AQP4-IgG seropositive (18/19). The median disease duration was 15 years (range=10-39) and most patients presented a relapsing clinical course (84.2%). The median duration of treatment was 11.9 years (range=10.0-23.8). The median annualized relapse rates (ARR) pre- and post-treatment with azathioprine were 1 (range=0.1-2) and 0.1 (range=0-0.35); p=0.09. Three patients (15.7%) had records of adverse events during the follow-up, which consisted of chronic B12 vitamin deficiency, pulmonary tuberculosis and breast cancer. Conclusion: Azathioprine may be considered a safe agent for long-term treatment (>10 years) of NMOSD, but continuous vigilance for infections and malignancies is required.

RESUMO

Introdução: A azatioprina é um tratamento comum de primeira linha para os transtornos do espectro neuromielite óptica (NMOSD). Objetivo: Este estudo visou determinar a segurança do tratamento a longo prazo (>10 anos) da NMOSD com a azatioprina. Métodos: Foi realizada revisão retrospectiva de todos os prontuários de pacientes que preenchiam critérios de NMOSD de acordo com o “International Consensus Diagnostic Criteria for NMOSD” de 2015 em uso de azatioprina por ao menos 10 anos matriculados no ambulatório de Doenças Desmielinizantes do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Resultados: De 375 pacientes avaliados, 19 preencheram critérios de inclusão para análise. A mediana de idade foi de 44 anos (variância=28-61); os pacientes eram predominantemente do sexo feminino (17/19) e AQP4-IgG soropositivos (18/19). A mediana do tempo de duração de doença foi 11,9 anos (variância=10,0-23,8), a mediana da taxa anualizada de surtos pré e pós-tratamento foi de 1 (variância=0,1-2) e 0,1 (variância=0-0,35), p=0,09. Três pacientes (15,7%) apresentaram registro de eventos adversos durante o seguimento: deficiência crônica de vitamina B12, tuberculose pulmonar e câncer de mama. Conclusão: A azatioprina provavelmente pode ser considerada segura para o tratamento a longo prazo (>10 anos) da NMOSD, porém vigilância contínua de neoplasias e infecções é necessária.

Keywords:

Azathioprine - Neuromyelitis Optica - Therapeutics

Palavras-chave:

Azatioprina - Neuromielite Óptica - Terapêutica

Authors’ contributions:

ABAGRG designed the study, acquired the data, analyzed and interpreted the data, and drafted the manuscript for intellectual content. MSP analyzed and interpreted the data, and drafted the manuscript for intellectual content. DKS reviewed the manuscript for intellectual content. DC designed the study and drafted the manuscript for intellectual content. SLAP designed the study and drafted the manuscript for intellectual content.




Publication History

Received: 10 February 2020

Accepted: 25 June 2020

Article published online:
07 June 2023

© 2021. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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