title: Efficacy of azathioprine on multiple sclerosis new brain lesions evaluated using magnetic resonance imaging.
abstract: BACKGROUND
  Azathioprine is an immunosuppressive agent that reduces relapse rates in patients with multiple sclerosis (MS), but its efficacy in suppressing new brain lesions has never been evaluated.
  
  
  OBJECTIVE
  To evaluate the efficacy of azathioprine therapy on new brain lesion suppression in MS.
  
  
  METHODS
  Open-label treatment vs baseline study.
  
  
  METHODS
  Outpatient MS clinical center at a university hospital.
  
  
  METHODS
  Fourteen patients with relapsing-remitting MS of short duration and at least 3 gadolinium-enhancing (Gd+) brain lesions observed within 6 months before treatment.
  
  
  METHODS
  Azathioprine, up to 3 mg/kg daily, individually adjusted according to blood lymphocyte number and the occurrence of adverse events.
  
  
  METHODS
  Brain Gd+ lesions evaluated by monthly magnetic resonance imaging for 6 months before and 6 months during treatment and new T2 lesions evaluated during the same periods and after an additional 6 months.
  
  
  RESULTS
  The treatment reduced to 0 the median Gd+ lesion number and volume per magnetic resonance image (P<.001 for both), resulting in a Gd+ lesion number reduction of 50% or more in 12 of 14 patients (P<.01). An equivalent reduction in the new T2 lesion number was observed (P<.02); this activity also persisted during the additional treatment period evaluated using this outcome measure (P<.01). The median azathioprine dose administered (2.6-2.8 mg/kg daily) reduced the mean blood lymphocyte count to 57% of the baseline value. Adverse events were transient or reversible with dose adjustment.
  
  
  CONCLUSIONS
  This study indicates for the first time that azathioprine, administered at lymphocyte-suppressing doses, is effective in reducing MS new brain inflammatory lesions and is well tolerated.
authors.affiliation: Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy. massacesi@unifi.it
authors.forename: Luca
authors.initials: L
authors.lastname: Massacesi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Parigi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Barilaro
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Repice
authors.forename: Gianni
authors.initials: G
authors.lastname: Pellicanò
authors.forename: Angela
authors.initials: A
authors.lastname: Konze
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Siracusa
authors.forename: Rosanna
authors.initials: R
authors.lastname: Taiuti
authors.forename: Luigi
authors.initials: L
authors.lastname: Amaducci
mesh_terms: D000328:Adult; D001379:Azathioprine / Q000008:administration & dosage* / Q000009:adverse effects; D001921:Brain / Q000187:drug effects* / Q000473:pathology* / Q000503:physiopathology; D018592:Cross-Over Studies; D004305:Dose-Response Relationship, Drug; D004660:Encephalitis / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology; D005260:Female; D005682:Gadolinium; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000187:drug effects; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy* / Q000473:pathology* / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D005682:Gadolinium; D001379:Azathioprine