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Safety of Azathioprine Therapy Adjusted to Thiopurine Methyltransferase Activity in the Treatment of Infantile Atopic Dermatitis. Report on 7 Cases
Seguridad de azatioprina según los niveles de tiopurina metiltransferasa en el tratamiento de la dermatitis atópica infantil. Experiencia en 7 casos
R.M. Martel
, P. Melwani, D. Islas, Y. Peñate, L. Borrego
Corresponding author
Servicio de Dermatología, Hospital Universitario Insular de Gran Canaria, Gran Canaria, Spain
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Izu Belloso" "autores" => array:1 [ 0 => array:2 [ "nombre" => "R.M." "apellidos" => "Izu Belloso" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219010706636?idApp=UINPBA000044" "url" => "/15782190/0000010100000005/v1_201304241523/S1578219010706636/v1_201304241523/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Safety of Azathioprine Therapy Adjusted to Thiopurine Methyltransferase Activity in the Treatment of Infantile Atopic Dermatitis. Report on 7 Cases" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "415" "paginaFinal" => "420" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "R.M. Martel, P. Melwani, D. Islas, Y. Peñate, L. Borrego" "autores" => array:5 [ 0 => array:4 [ "nombre" => "R.M." "apellidos" => "Martel" "email" => array:2 [ 0 => "rmartel@aedv.es" 1 => "rosa2martel@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor1" ] ] ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Melwani" ] 2 => array:2 [ "nombre" => "D." "apellidos" => "Islas" ] 3 => array:2 [ "nombre" => "Y." "apellidos" => "Peñate" ] 4 => array:2 [ "nombre" => "L." "apellidos" => "Borrego" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Insular de Gran Canaria, Gran Canaria, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Seguridad de azatioprina según los niveles de tiopurina metiltransferasa en el tratamiento de la dermatitis atópica infantil. Experiencia en 7 casos" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2009-07-14" "fechaAceptado" => "2009-12-16" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec84759" "palabras" => array:3 [ 0 => "Atopic dermatitis" 1 => "Azathioprine" 2 => "Thiopurine methyltransferase" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec84758" "palabras" => array:3 [ 0 => "Dermatitis atópica" 1 => "Azatioprina" 2 => "Tiopurina metiltransferasa" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p class="elsevierStyleSimplePara elsevierViewall">In a small number of cases of childhood atopic dermatitis, topical therapy is ineffective, necessitating prolonged use of systemic immunosuppressants. Over the last few years, a better understanding of the metabolic pathways involved in azathioprine breakdown has enabled us to use this drug more safely. In this study, we evaluated the toxicity of azathioprine treatment adjusted to thiopurine methyltransferase activity in children with severe atopic dermatitis.</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p class="elsevierStyleSimplePara elsevierViewall">We performed a retrospective study of the side effects of azathioprine therapy adjusted to thiopurine methyltransferase activity in children aged under 14 years with atopic dermatitis who were treated in the dermatology department of Hospital Universitario Insular de Gran Canaria in Gran Canaria, Spain. Side effects were evaluated by analysis of leukocyte count and transaminase levels at baseline, after 1 month of treatment, and every 3 months thereafter.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">During the last 4 years, 7 children (mean age, 10 years) with severe atopic dermatitis received azathioprine in our department. Mean duration of treatment was 12 months (range, 1 to 38 months). Only 2 patients presented mild transient leukopenia that did not require treatment to be suspended.</p> <span class="elsevierStyleSectionTitle">Discussion</span><p class="elsevierStyleSimplePara elsevierViewall">Our experience shows that, when adjusted to thiopurine methyltransferase activity, azathioprine is a safe drug for the treatment of children with severe atopic dermatitis. However, clinical trials should be performed to compare the risk-benefit ratios of the different immunosuppressants used to treat these patients.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p class="elsevierStyleSimplePara elsevierViewall">Existe un pequeño número de casos de dermatitis atópica (DA) infantil donde la terapia tópica es insuficiente para el control de la enfermedad y es necesario el uso prolongado de agentes inmunosupresores sistémicos. En los últimos años el mejor conocimiento de las vías metabólicas implicadas en la catabolización de la azatioprina (AZT) parece ofrecernos un uso más seguro de este fármaco. Hemos evaluado la toxicidad de la AZT según los niveles de tiopurina metiltransferasa (TPMT) en niños con DA grave.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo de los efectos secundarios de la AZT ajustada a los niveles de TPMT en menores de 14 años con DA que han sido tratados en el Servicio de Dermatología del Hospital Universitario Insular de Gran Canaria. La evaluación de los efectos secundarios se realizó mediante controles analíticos con recuento leucocitario y de transaminasemia en la visita basal, al mes y cada tres meses durante el tratamiento.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">En los últimos 4 años, 7 niños (media de 10 años) con DA grave han recibido AZT en nuestro Servicio. La duración media del tratamiento fue de 12 meses (rango 1–38); sólo dos pacientes presentaron una leucopenia leve transitoria que no requirió la suspensión del tratamiento.</p> <span class="elsevierStyleSectionTitle">Discusión</span><p class="elsevierStyleSimplePara elsevierViewall">Según nuestra experiencia la AZT, ajustada a los niveles de TPMT, se muestra como un fármaco seguro en el tratamiento de niños con DA grave, aunque son precisos ensayos clínicos que comparen la relación riesgo/beneficio entre los inmunosupresores empleados en estos pacientes.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermatitis atópica infantil: revisión y actualización" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 10 | 14 |
| 2024 October | 54 | 42 | 96 |
| 2024 September | 52 | 25 | 77 |
| 2024 August | 66 | 54 | 120 |
| 2024 July | 64 | 26 | 90 |
| 2024 June | 58 | 34 | 92 |
| 2024 May | 56 | 30 | 86 |
| 2024 April | 39 | 19 | 58 |
| 2024 March | 59 | 29 | 88 |
| 2024 February | 41 | 34 | 75 |
| 2024 January | 35 | 29 | 64 |
| 2023 December | 35 | 19 | 54 |
| 2023 November | 45 | 45 | 90 |
| 2023 October | 43 | 42 | 85 |
| 2023 September | 49 | 26 | 75 |
| 2023 August | 31 | 24 | 55 |
| 2023 July | 51 | 45 | 96 |
| 2023 June | 37 | 23 | 60 |
| 2023 May | 39 | 26 | 65 |
| 2023 April | 38 | 19 | 57 |
| 2023 March | 29 | 19 | 48 |
| 2023 February | 28 | 23 | 51 |
| 2023 January | 27 | 25 | 52 |
| 2022 December | 37 | 25 | 62 |
| 2022 November | 17 | 35 | 52 |
| 2022 October | 19 | 26 | 45 |
| 2022 September | 16 | 38 | 54 |
| 2022 August | 18 | 38 | 56 |
| 2022 July | 21 | 42 | 63 |
| 2022 June | 16 | 37 | 53 |
| 2022 May | 19 | 35 | 54 |
| 2022 April | 28 | 37 | 65 |
| 2022 March | 27 | 50 | 77 |
| 2022 February | 22 | 27 | 49 |
| 2022 January | 19 | 40 | 59 |
| 2021 December | 20 | 40 | 60 |
| 2021 November | 24 | 45 | 69 |
| 2021 October | 29 | 54 | 83 |
| 2021 September | 22 | 44 | 66 |
| 2021 August | 15 | 39 | 54 |
| 2021 July | 13 | 33 | 46 |
| 2021 June | 44 | 35 | 79 |
| 2021 May | 30 | 22 | 52 |
| 2021 April | 65 | 44 | 109 |
| 2021 March | 61 | 31 | 92 |
| 2021 February | 72 | 30 | 102 |
| 2021 January | 34 | 22 | 56 |
| 2020 December | 30 | 19 | 49 |
| 2020 November | 22 | 23 | 45 |
| 2020 October | 17 | 12 | 29 |
| 2020 September | 29 | 19 | 48 |
| 2020 August | 55 | 19 | 74 |
| 2020 July | 34 | 13 | 47 |
| 2020 June | 21 | 30 | 51 |
| 2020 May | 29 | 21 | 50 |
| 2020 April | 23 | 23 | 46 |
| 2020 March | 16 | 20 | 36 |
| 2020 February | 4 | 0 | 4 |
| 2020 January | 0 | 13 | 13 |
| 2019 December | 0 | 9 | 9 |
| 2019 November | 0 | 3 | 3 |
| 2019 October | 0 | 5 | 5 |
| 2019 August | 0 | 2 | 2 |
| 2019 July | 0 | 9 | 9 |
| 2019 June | 0 | 10 | 10 |
| 2019 May | 2 | 35 | 37 |
| 2019 March | 0 | 11 | 11 |
| 2019 February | 0 | 5 | 5 |
| 2018 March | 6 | 2 | 8 |
| 2018 February | 11 | 3 | 14 |
| 2018 January | 7 | 5 | 12 |
| 2017 December | 21 | 8 | 29 |
| 2017 November | 8 | 5 | 13 |
| 2017 October | 12 | 8 | 20 |
| 2017 September | 22 | 4 | 26 |
| 2017 August | 35 | 8 | 43 |
| 2017 July | 37 | 0 | 37 |
| 2017 June | 32 | 7 | 39 |
| 2017 May | 34 | 10 | 44 |
| 2017 April | 29 | 10 | 39 |
| 2017 March | 33 | 24 | 57 |
| 2017 February | 24 | 5 | 29 |
| 2017 January | 15 | 6 | 21 |
| 2016 December | 30 | 5 | 35 |
| 2016 November | 21 | 3 | 24 |
| 2016 October | 18 | 18 | 36 |
| 2016 September | 29 | 8 | 37 |
| 2016 August | 28 | 6 | 34 |
| 2016 July | 32 | 7 | 39 |
| 2016 June | 7 | 9 | 16 |
| 2016 May | 9 | 0 | 9 |
| 2016 April | 10 | 1 | 11 |
| 2016 March | 5 | 0 | 5 |
| 2016 February | 5 | 2 | 7 |
| 2016 January | 8 | 0 | 8 |
| 2015 December | 10 | 1 | 11 |
| 2015 November | 7 | 3 | 10 |
| 2015 October | 8 | 4 | 12 |
| 2015 September | 10 | 3 | 13 |
| 2015 August | 19 | 5 | 24 |
| 2015 July | 15 | 4 | 19 |
| 2015 June | 21 | 6 | 27 |
| 2015 May | 49 | 13 | 62 |
| 2015 April | 28 | 8 | 36 |
| 2015 March | 39 | 13 | 52 |
| 2015 February | 26 | 20 | 46 |
| 2015 January | 21 | 14 | 35 |
| 2014 December | 28 | 20 | 48 |
| 2014 November | 18 | 12 | 30 |
| 2014 October | 22 | 20 | 42 |
| 2014 September | 32 | 11 | 43 |
| 2014 August | 28 | 17 | 45 |
| 2014 July | 35 | 13 | 48 |
| 2014 June | 32 | 11 | 43 |
| 2014 May | 33 | 10 | 43 |
| 2014 April | 31 | 6 | 37 |
| 2014 March | 40 | 14 | 54 |
| 2014 February | 24 | 13 | 37 |
| 2014 January | 32 | 9 | 41 |
| 2013 December | 27 | 11 | 38 |
| 2013 November | 19 | 12 | 31 |
| 2013 October | 29 | 17 | 46 |
| 2013 September | 31 | 23 | 54 |
| 2013 August | 16 | 15 | 31 |
| 2013 July | 19 | 41 | 60 |
| 2013 June | 19 | 11 | 30 |
| 2013 May | 12 | 12 | 24 |
| 2013 April | 23 | 23 | 46 |
| 2013 March | 22 | 17 | 39 |
| 2013 February | 11 | 11 | 22 |
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