Treatments

Azathioprine

Azathioprine (AZA) is one of the second-line immunosuppressive agents used in the treatment of non-infectious uveitis. The medication lowers the inflammation in the body by reducing the immune system activity.

AZA is usually prescribed in the following situations:

When the dose of prednisolone to maintain the quiescence of uveitis is unacceptable because high (>7.5mg/day maintenance)
When recurrent high doses of steroids are needed for relapsing disease  
When the use of immunosuppressive therapy is needed at presentation due to severity of uveitis
When a steroid-sparing agent is needed due to prednisolone side effects

therapy

AZA is usually taken daily in a dose of 1-3mg/kg/day to a maximum of 200mg/day if tolerated (divided in doses). The amount to take depends on the body weight and on the severity of the disease.

The medication should be taken on an empty stomach, either one hour before or three hours after meals.

For it to work well, the medication should be taken regularly. Patients should not be discouraged if the results are not immediate, because the drug takes several weeks to months to become effective on the uveitis. A reasonably long period of therapy (2 years) is usually required as maintenance therapy in most cases. However, AZA does not help everyone who takes it and in some patients the condition might not improve.

Side effects

The use of AZA can be associated with side effects. Not everyone will develop side effects from the use of the medication and presence of side effects varies from person to person.

Potential side effects include:

Gastrointestinal symptoms (abdominal pain, nausea, diarrhoea, vomiting)  
Leukopenia and thrombocytopenia (reduction in the level of certain blood cells) - patients should be warned to report immediately any infections and inexplicable bruising or bleeding  
Renal or liver impairment
Hypersensitivity reactions (malaise, dizziness, vomiting, fever, diarrhoea, arthralgia, myalgia, rash, hypotension) – withdraw drug immediate
Increased risk of skin cancer - avoid exposure to UV and strong sunlight, use sun block, long sleeves, etc., lymphoma and cervical cancer

If patients experience side effects after taking AZA, they should report them immediately to the doctor. Most side effects should improve when reducing the dosage or eventually stop the medication.

Certain medical conditions contraindicate the use of AZA, including:

Other conditions required cautions in the administration of the drug. The doctor need to be informed in case of:

Patients should inform the doctor about any medications they have been taken, due to potential risk of AZA interaction with other drugs, and about allergy to medications.

Viral infections and vaccinations

As AZA reduce the ability of the immune system to fight infections, patients on treatment are more likely to catch infections of the skin, mouth, stomach, intestines, lungs and urinary tract. Patients should report symptoms of infections to the doctor.

Patients should avoid live vaccines while on AZA, including yellow fever, rubella and MMR. It is safe to have the flu vaccination and Pneumovax as they are not live vaccines.

Monitoring

Patients are regularly checked while on treatment.

Before starting the therapy an initial blood test is carried out

While on treatment, blood monitoring, including FBC, U&E and LFT is performed every 2 weeks for 6 weeks, then monthly for 3 months and then at least every 12 weeks.  

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