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Azathioprine for rheumatoid arthritis
M E Suarez-Almazor1, C Spooner, E Belseck
1Health Services Research, Veterans Affairs Medical Center, Mailbox Station 152, 2002 Holcombe Blvd, Houston, Texas 77024, USA. mes@bcm.tmc.edu
The Cochrane Database of Systematic Reviews
|May 5, 2000
Summary
Azathioprine shows a short-term benefit for rheumatoid arthritis joint pain but has higher toxicity. Due to the risk-benefit ratio, it is not recommended over other disease-modifying anti-rheumatic drugs.
Area of Science:
- Rheumatology
- Clinical Pharmacology
- Evidence-Based Medicine
Background:
- Rheumatoid arthritis (RA) is a chronic autoimmune disease requiring effective treatment.
- Azathioprine is an immunosuppressive drug sometimes used in RA management.
Purpose of the Study:
- To evaluate the short-term efficacy and safety of azathioprine in rheumatoid arthritis patients.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) and controlled clinical trials.
- Searched major databases (Cochrane, Medline, Embase) up to July 1998.
- Pooled analysis of outcome measures including joint counts, pain, ESR, and toxicity.
Main Results:
- Three trials with 81 patients compared azathioprine to placebo.
- Azathioprine demonstrated a statistically significant benefit in reducing tender joint scores.
- Higher rates of withdrawal due to adverse reactions were observed with azathioprine.
Conclusions:
- Azathioprine offers short-term improvement in joint disease activity for RA patients.
- Evidence is limited by small patient numbers and older trials.
- Increased toxicity and a poor risk-benefit ratio suggest azathioprine is not preferable to other DMARDs.