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Azathioprine
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===Others=== Azathioprine is sometimes used in systemic lupus erythematosus, requiring a maintenance dose of 15 mg or higher of [[prednisone]] in those who experience recurrent flares.<ref name=Abu2001>{{cite journal | vauthors = Abu-Shakra M, Shoenfeld Y | title = Azathioprine therapy for patients with systemic lupus erythematosus | journal = Lupus | volume = 10 | issue = 3 | pages = 152β153 | year = 2001 | pmid = 11315344 | doi = 10.1191/096120301676669495 | s2cid = 71558242 }}</ref> It is used as an add-on therapy when steroid therapy is given by mouth for pemphigus and myasthenia gravis, as a "steroid-sparing" agent.<ref name="derma" /><ref>{{cite journal | vauthors = Olszewska M, Kolacinska-Strasz Z, Sulej J, Labecka H, Cwikla J, Natorska U, Blaszczyk M | title = Efficacy and safety of cyclophosphamide, azathioprine, and cyclosporine (ciclosporin) as adjuvant drugs in pemphigus vulgaris | journal = American Journal of Clinical Dermatology | volume = 8 | issue = 2 | pages = 85β92 | year = 2007 | pmid = 17428113 | doi = 10.2165/00128071-200708020-00004 | s2cid = 10699017 }}</ref><ref>{{cite journal | vauthors = Richman DP, Agius MA | title = Treatment of autoimmune myasthenia gravis | journal = Neurology | volume = 61 | issue = 12 | pages = 1652β1661 | date = December 2003 | pmid = 14694025 | doi = 10.1212/01.wnl.0000098887.24618.a0 | s2cid = 24755812 }}</ref> Azathioprine is also used to maintain remission in people who have granulomatosis with polyangiitis.<ref name=Sing2017/> It can be very effective in eczema and atopic dermatitis, though it is not commonly used.<ref name="derma" /> The British National Eczema Society lists it as a [[Drug of last resort|third-line treatment]] for severe to moderate cases of these skin diseases.<ref>{{cite journal | vauthors = Meggitt SJ, Gray JC, Reynolds NJ | title = Azathioprine dosed by thiopurine methyltransferase activity for moderate-to-severe atopic eczema: a double-blind, randomised controlled trial | journal = Lancet | volume = 367 | issue = 9513 | pages = 839β846 | date = March 2006 | pmid = 16530578 | doi = 10.1016/S0140-6736(06)68340-2 | s2cid = 1616660 }}</ref> It was widely used to treat multiple sclerosis until the first half of the 1990s. Concerns about increased risk of [[malignancy]] have led to a decreased use, yet it is still used in maintenance treatment for people who frequently [[relapse]].<ref>{{cite journal | vauthors = Casetta I, Iuliano G, Filippini G | title = Azathioprine for multiple sclerosis | journal = Journal of Neurology, Neurosurgery, and Psychiatry | volume = 80 | issue = 2 | pages = 131β2; discussion 132 | date = February 2009 | pmid = 19151017 | doi = 10.1136/jnnp.2008.144972 | s2cid = 207001537 }}</ref> A 2007 Cochrane review found that azathioprine reduced the number of relapses in the first year of treatment and disease progression in the first two to three years and did not find an increase in cancer, and noted the need for direct comparison of azathioprine and [[Interferon-beta|interferon beta]], conflicting conclusions regarding cancer, and the potential for long-term risks.<ref>{{cite journal | vauthors = Casetta I, Iuliano G, Filippini G | title = Azathioprine for multiple sclerosis | journal = The Cochrane Database of Systematic Reviews | volume = 2007 | issue = 4 | pages = CD003982 | date = October 2007 | pmid = 17943809 | pmc = 6823213 | doi = 10.1002/14651858.CD003982.pub2 }}</ref> A widely used therapy for [[idiopathic pulmonary fibrosis]] was azathioprine in combination with prednisone and ''N''-[[acetylcysteine]]. A 2012 study showed that this combination produced worse outcomes than a placebo.<ref>{{cite journal | vauthors = Raghu G, Anstrom KJ, King TE, Lasky JA, Martinez FJ | title = Prednisone, azathioprine, and N-acetylcysteine for pulmonary fibrosis | journal = The New England Journal of Medicine | volume = 366 | issue = 21 | pages = 1968β1977 | date = May 2012 | pmid = 22607134 | pmc = 3422642 | doi = 10.1056/NEJMoa1113354 }}</ref>
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