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Azathioprine

Azathioprine acts to inhibit the proliferation of cells, especially white blood cells including T cells. It is usually used in combination with other immunosuppressants in organ transplantation. Its most severe side effect is bone marrow suppression, which prevents the formation of blood cells. It interacts with allopurinol, a drug used to prevent gout, and so the two should either not be given together or doses should be reduced.

antimetabolites


Azathioprine was first introduced into clinical practice by Sir Roy Calne, the British pioneer in transplantation. Following the work done by Sir Peter Medawar in discovering the immunological basis of rejection of transplanted tissues and organs, a great deal of research was carried out to discover drugs to suppress this immune reaction. Sir Roy Calne, working as a researcher in the pioneering kidney transplant unit at the Brigham Hospital in Boston (USA), conducted experiments into the use of the drug 6-mercaptopurine as an immunosuppressant for kidney transplants. When azathioprine was discovered, he then introduced it as a less toxic replacement for 6-mercaptopurine. For many years, dual therapy with azathioprine and steroids was the standard anti-rejection regime, until ciclosporin was gradually introduced into clinical practice (also by Sir Roy Calne) from 1978.

Azathioprine is also used for some conditions caused by an over-active immune system, such as rheumatoid arthritis and Crohn’s disease.