Журнал болезней легких и лечения

Azathioprine in Connective Tissue Disease-Associated Interstitial Lung Diseases. How Valuable?

Abstract

Aldehaim AY, AboAbat A and Abdulmajeed A

Objective: To systematically review the use of azathioprine as a treatment for connective tissue diseaseassociated interstitial lung disease (CTD-ILD) in terms of effectiveness and safety.

Materials and methods: A literature search was performed using the PubMed, EMBASE, CINAHL, Cochrane, and Scopus databases. The search was restricted to articles published in English from 1950 to March 2018 that examined the use of azathioprine in patients with CTD-ILD and determined its effects on a primary or secondary endpoint. This review included studies that measured the impacts of azathioprine in terms of effectiveness and safety.

Results: The search identified 15 studies with a total of 424 subjects. Two hundred twenty patients received azathioprine. A majority of the studies failed to provide clear evidence for the effectiveness of azathioprine. The reported adverse events were: death 4.5% (n=10), infection 1.3% (n=3), myelosuppression 0.9% (n=2), and malignancy 0.45% (n=1). The rate of azathioprine discontinuation due to treatment failure was 2.7% (n=6).

Conclusions: No clear impacts of azathioprine have been reported, yet this review reveals that the drug is less useful than previously believed. In contrast to our current knowledge, this review suggests that the ILD histopathological pattern appears to be the most important determinant of treatment responses and prognosis, and treatment decisions should be based on this parameter, rather than the background CTD. AZA is a relatively safe option. More well-designed studies are needed. The recruitment of subjects based on the ILD pattern rather than CTD may produce more consistent results.