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AZ

azathioprine (azathioprine, Salix / Azasan / Azasan)

✓ Approved

Salix · Small Molecule · Small Molecule

What is azathioprine?

azathioprine is a small molecule developed by Salix. It is approved for therapeutic indications via oral (po).

Drug Profile

Brand Namesazathioprine, Salix, Azasan, Azasan
CompanySalix
Drug ClassSmall Molecule
RouteOral (PO)
StatusApproved
Sources: ClinicalTrials.gov, Salix

Therapeutic Indications

azathioprine is developed for 2 unique indications across 2 therapeutic areas.

Therapeutic AreaConditionPhase
Musculoskeletal and connective tissue disordersRheumatoid arthritis✓ Approved
Immune system disordersSolid organ transplant rejection✓ Approved

Related Research Articles

PubMedJournal of pediatric gastroenterology and nutrition2026-08-24

Growth and development in paediatric onset inflammatory bowel disease: Data analysis from the CEDATA registry.

Broekaert Ilse I, Schmidt Anna A, Hünseler Christoph C, Delaffolie Jan J et al.

Different therapies may affect the growth and development of children and adolescents with inflammatory bowel disease (IBD) supporting specific therapy algorithms for paediatric Crohn's disease (CD) and ulcerative colitis (UC). Growth and development data from the German-Austrian CEDATA-GPGE registry entered between 2004 and 2021 were analysed for 0-18 year olds with complete follow-up on diagnoses and therapies. Standard deviation scores (SDS) for height, weight, and body mass index (BMI) were compared between initial diagnosis (t0) and 4-year follow-up (t4) within groups using multivariate analysis. Factors included gender, age, disease type, age at diagnosis, and initial therapies. Data from 450 patients (CD: 303; UC: 147) were analysed. At t0, SDS values for height (mean value [M] = -0.37, standard deviation [SD] = 1.07), weight (M = -0.57, SD = 0.92), and BMI (M = -0.55, SD = 0.95) were below average. The SDS values for weight and BMI increased significantly between t0 and t4 with small effect sizes, whereas the SDS value for height did not. Diagnosis, gender, disease localisation, and remission after 6 months did not influence height SDS. Patients treated exclusively with enteral nutrition (EEN) or azathioprine showed improved weight and BMI development, whereas corticosteroids led to weight gain. The analysis showed that EEN and disease control significantly improve weight and BMI in children with IBD, SDS-H catch-up was only observed in the subgroup with growth impairment at initial diagnosis. Children with severe or recurrent flares, or persistent nutritional deficits, are at increased risk of growth impairment and require close medical monitoring.

PMID 42634419
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PubMedCureus2026-08-24

Pediatric Post-COVID-19 Neuromyelitis Optica Spectrum Disorder: A Case Report.

Espinel-Porras Julieth Bibiana JB, Arenas Laura Daniela LD, Mora-Bautista Victor Manuel VM

Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune astrocytopathy affecting the central nervous system, particularly the optic nerves and spinal cord. Post-infectious triggers, including SARS-CoV-2 (COVID-19), have been increasingly recognized as potential catalysts for this immune-mediated condition. We report the case of a nine-year-old boy who developed AQP4-IgG-positive NMOSD following confirmed SARS-CoV-2 infection. The patient's clinical onset began 1.5 months prior to admission with a seven-day episode of intractable vomiting, indicative of area postrema syndrome (APS). He subsequently presented with a 20-day history of progressive gait weakness, dysarthria, and complex ocular and cranial nerve deficits. Neurological examination revealed a right one-and-a-half syndrome, bilateral sixth cranial nerve paresis, left peripheral facial paresis, profound bulbar dysfunction (including a weak gag reflex and bilateral 12th nerve paresis), lower limb weakness (4/5), gait ataxia, and bilateral extensor plantar responses. Magnetic resonance imaging (MRI) demonstrated extensive central nervous system involvement. Brain MRI revealed typical hyperintense lesions in the periventricular white matter, thalamic-hypothalamic area, midbrain, medulla, and area postrema, alongside bilateral retrobulbar optic nerve enhancement. Spinal imaging confirmed longitudinally extensive transverse myelitis (LETM) spanning the C1-C6 and T2-T6 levels, featuring central gray matter involvement (H-sign) extending into the lateral columns. Cerebrospinal fluid was largely unremarkable. Serological testing confirmed the diagnosis with positive aquaporin-4 (AQP4)-IgG antibodies (cell-based assay (CBA)), positive antinuclear antibodies (ANAs) (1:80), and positive COVID-19 IgG antibodies, while anti-MOG antibodies were negative. Acute targeted immunotherapy was initiated with high-dose intravenous methylprednisolone (30 mg/kg/day for five days). While this achieved complete resolution of his gait abnormalities, visual impairment persisted. He subsequently underwent five sessions of therapeutic plasmapheresis as rescue therapy, resulting in full visual and neurological recovery. The patient was discharged on a maintenance regimen of oral azathioprine (2 mg/kg/day) and biannual intravenous rituximab. A four-month follow-up MRI confirmed dramatic radiologic improvement, with complete resolution of the spinal cord abnormalities. This pediatric case highlights post-COVID-19 NMOSD as a severe but highly treatable neurological emergency. It underscores the critical need for rapid diagnosis through detailed clinical recognition (including preceding APS), advanced radiographic imaging, and targeted serologic evaluation, as well as the efficacy of plasmapheresis for steroid-refractory symptoms to prevent irreversible disability.

PMID 42634781
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PubMedScientific reports2026-08-23

Upregulation of serum circular RNA FUNDC1 and TNF-α in Behçet's disease: potential diagnostic biomarkers.

Marzouk Rehab Elsayed RE, Kamel Marwa M, Shaker Olfat G OG, Gameil Mohammed Ali MA et al.

Behçet's disease (BD) is an inflammatory autoimmune disease characterized by relapsing genital ulcers, ocular involvement, and intestinal disorders. Evaluate serum levels of circular RNA (circRNA) FUNDC1 and tumor necrosis factor-alpha (TNF-α) in BD patients and compare them accordingly to healthy individuals. One hundred participants were enrolled in this study and subdivided equally into BD patients and healthy matched individuals. A five mL sample of blood was drawn from each subject and analyzed to measure circRNA-FUNDC1 and TNF-α. Full clinical investigations have been performed, and the Behcet Disease Current-Activity Form score (BDCAF) has been calculated. circRNA-FUNDC1 and TNF-α were measured by quantitative real time PCR and enzyme-linked immunosorbent assay (ELISA) respectively. An up-regulation of circRNA-FUNDC1 as well as TNF-α (p < 0.0001) in BD group were reported compared to controls. Both biomarkers tended to elevate with the activity of the disease as levels were higher in active BD patients than inactive patients. The level of circRNA-FUNDC1 (FC) tended to be higher in patients with negative musculoskeletal and central nervous system (CNS) manifestations than those with positive manifestations (p-values = 0.007, 0.037, respectively). The level of TNF-α was reported higher in those with oral ulcer with (p = 0.041), also in patients with positive skin manifestations than in negative patients (p = 0.025). The level of circRNA-FUNDC1 (FC) was higher in patients who took Azathioprine and steroids (p = 0.019, 0.035) and lower in patients who took cyclosporin (p = 0.049). TNF-α tended to elevate in patients who took Hydroxychloroquine than those who did not (p = 0.040). The upregulated levels of circRNA-FUNDC1 and TNF-α may have a potential role in improving our understanding of the molecular mechanisms underlying BD.

PMID 42632834
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PubMedTransactions of the Royal Society of Tropical Medicine and Hygiene2026-08-22

Chronic erythema nodosum leprosum in Hansen's disease: a challenging clinical management.

Spinicci Michele M, Barbiero Anna A, Manciulli Tommaso T, Fiorelli Costanza C et al.

Chronic erythema nodosum leprosum (ENL) is a challenging complication of Hansen's disease (HD), with limited treatment options and frequent steroid dependence. Anti-tumour necrosis factor (TNF)-α agents are promising alternatives, though evidence remains confined to a few reports. We report the case of a 34-year-old Moroccan man with multibacillary Hansen's disease, who developed chronic ENL with recurrent systemic and cutaneous flares, requiring prolonged immunomodulatory therapy. Corticosteroids, thalidomide, azathioprine, methotrexate, and anti-TNF-α therapy only provided incomplete control. After six years of recurrences requiring several hospitalizations, treatment with methylprednisolone, high-dose thalidomide, and clofazimine achieved a sustained remission, allowing gradual treatment discontinuation.

PMID 42631419
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PubMedHeart failure reviews2026-08-21

Giant cell myocarditis: from immune pathogenesis to contemporary management.

Vosko Ivan I, Wallner Markus M

Giant cell myocarditis (GCM) is a rare but devastating inflammatory cardiac disease characterized by rapid hemodynamic deterioration, malignant arrhythmias, and high rates of death or heart transplantation. Without immunosuppressive treatment, median transplant-free survival is approximately three months. Current evidence identifies GCM as a predominantly T cell-mediated autoimmune disorder driven by a breakdown of immune tolerance, with contributions from macrophage-derived multinucleated giant cells and neutrophil extracellular trap formation. Viral infections and environmental factors have been implicated as potential triggers. GCM typically affects middle-aged adults, with concomitant non-cardiac autoimmune diseases present in approximately 20% of cases. Early diagnosis remains challenging, as clinical presentation and imaging findings are nonspecific and overlap considerably with cardiac sarcoidosis. Endomyocardial biopsy continues to represent the diagnostic gold standard, with a sensitivity of 85%, while cardiac biomarkers including cardiac troponins and NT-proBNP provide important prognostic information. Cardiac magnetic resonance imaging and FDG-PET contribute to the diagnostic workup but cannot reliably differentiate GCM from cardiac sarcoidosis. Management requires prompt initiation of combination immunosuppressive therapy-typically corticosteroids combined with T cell-targeted agents such as cyclosporine and azathioprine or tacrolimus and mycophenolate mofetil, which has substantially improved survival in contemporary registries. Mechanical circulatory support and heart transplantation are frequently required for refractory cases. Given the high arrhythmic burden, systematic evaluation for implantable cardioverter-defibrillator placement is recommended. This review provides a comprehensive overview of the pathogenesis, diagnosis, and current management of GCM and highlights priorities for future research, including noninvasive diagnostic tools and standardized treatment protocols.

PMID 42624936
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PubMedJournal of paediatrics and child health2026-08-21

Idiopathic Acute Pancreatitis in Paediatric Inflammatory Bowel Disease: Clinical Features and Outcomes in a Retrospective Single-Centre Study.

Vazzana Giovanna Fernanda GF, Romano Alessia A, Romano Claudio C

To describe the clinical characteristics, timing, and long-term outcomes of idiopathic acute pancreatitis (AP) in paediatric inflammatory bowel disease (IBD) after systematic exclusion of secondary causes. We conducted a retrospective single-centre cohort study of paediatric IBD patients followed between January 2018 and December 2024. AP diagnosis and severity were classified according to the North American Society for Paediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) criteria. Patients with drug-induced, metabolic, infectious, genetic, or structural causes were excluded. Clinical, laboratory, imaging, and outcome data were analysed. Among 395 paediatric IBD patients, 16 (4.1%) developed AP. After excluding four azathioprine-related cases, 12 patients (3%) were included (50% male; median age 10.6 years). Ulcerative colitis (UC) predominated (67%), with colonic involvement in all cases. Idiopathic AP occurred during active disease in 75% and after IBD-related surgery in 25%. All episodes were mild and resolved with supportive management without complications. Ultrasound showed focal pancreatic inflammatory changes in 58% of patients, predominantly involving the body and tail, while diffuse pancreatic enlargement was reported in 5 patients (42%). Over a median follow-up of 3.7 years, 8/12 patients (67%) developed acute recurrent pancreatitis (ARP), with a median time to recurrence of 9 months. No patients developed pancreatic insufficiency or diabetes. Serum IgG4 levels were negative in all patients. Among those who developed ARP, genetic testing revealed no pathogenic variants. Idiopathic AP in children with IBD appeared to be a mild but potentially relapsing condition associated with active intestinal inflammation and colonic disease. Pancreatic function remained preserved despite recurrence, which may be consistent with an immune-mediated gut-pancreas axis. Given the limited sample size, these findings should be considered hypothesis-generating, and prospective multicentre studies are required to confirm these observations and better characterise the underlying pathogenesis.

PMID 42625467
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