Drug Database
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

PubMedFrontiers in immunology2026-10-15

Anti-interferon-γ autoantibodies: immunopathogenesis, diagnostic innovation, and emerging therapeutic strategies in an adult-onset immunodeficiency.

Tsai Chin-Shiang CS, Cheng Aristine A, Naz Farha F

Adult-onset immunodeficiency with anti-interferon-γ autoantibodies (AIGA) is a rare acquired immunodeficiency increasingly recognized in East and Southeast Asia, characterized by disseminated infections with nontuberculous mycobacteria and other intracellular pathogens. Recent studies have refined our understanding of its immunopathogenesis, including HLA-linked susceptibility, epitope-specific neutralization of IFN-γ, and molecular mimicry, while highlighting persistent gaps in diagnosis and treatment. This Perspective synthesizes emerging evidence into a clinically oriented framework spanning diagnosis, monitoring, and immunomodulatory therapy. We discuss functional confirmation of AIGA, repurposing of the QuantiFERON-TB platform as an accessible screening strategy, and quantitative titers and ¹8F-FDG PET as complementary biomarkers of disease activity and treatment response. We propose a clinical decision pathway in which refractory or progressive infection, rather than a fixed titer threshold, triggers immunomodulation, with rituximab and cyclophosphamide as the best-supported induction strategies, daratumumab reserved for refractory cases, and emerging AIGA-specific evidence supporting azathioprine for maintenance. Recognizing heterogeneous access to specialized testing and biologics across AIGA-endemic regions, we propose a resource-stratified approach integrating widely available markers with referral-based testing and resource-adapted treatment. We also highlight emerging antigen-specific strategies, including chimeric autoantibody receptor T cells engineered to eliminate autoantibody-producing B cells, as a future direction toward durable remission. Finally, we outline priorities for prospective validation and biomarker-guided therapy.

PMID 42876531
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PubMedFrontiers in medicine2026-10-15

Long-term upadacitinib treatment in a patient with atopic dermatitis, bullous pemphigoid, and alopecia areata: a case report and review of the literature.

Triolo Sara S, Bruni Manfredo M, Magnanimi Lina Maria LM, De Berardinis Andrea A et al.

Atopic dermatitis (AD), bullous pemphigoid (BP), and alopecia areata (AA) are immune-mediated dermatologic diseases characterized by distinct clinical features but partially overlapping immunopathogenic mechanisms. Their coexistence in a single patient is uncommon and may pose significant diagnostic and therapeutic challenges. We report the case of a 33-year-old woman with long-standing moderate-to-severe AD who subsequently developed BP, confirmed by histopathology and direct immunofluorescence. Initial treatment with systemic corticosteroids and conventional immunosuppressants, including azathioprine followed by cyclosporine, resulted in only transient improvement and was limited by adverse effects. Dupilumab was therefore initiated, leading to marked improvement of BP while maintaining remission of AD. However, after approximately six months of therapy, the patient developed new-onset patchy AA. Dupilumab was discontinued, and treatment was switched to upadacitinib, a selective Janus kinase 1 (JAK1) inhibitor. Early clinical improvement was observed after six weeks, with progressive hair regrowth and stable BP activity. Complete remission of BP was achieved after twelve weeks and complete remission of AA after twenty-four weeks, while remission of AD was maintained. Disease control was sustained throughout a twenty-four -month follow-up, without significant adverse events. This case underscores the diagnostic and therapeutic complexity associated with the coexistence of multiple immune-mediated dermatologic diseases. The sequential emergence of AD, BP, and AA highlights the challenges posed by overlapping inflammatory pathways and the need for alternative therapeutic strategies when pathway-specific treatments prove insufficient or poorly tolerated. These observations support the concept that broader immunomodulatory approaches targeting shared signaling pathways may enable simultaneous control of multiple inflammatory conditions. In this context, inhibition of the JAK-STAT pathway may represent a promising integrated therapeutic strategy in selected patients with complex immune-mediated dermatologic comorbidities.

PMID 42876461
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PubMedNutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition2026-10-14

Severe malnutrition and persistent myopenia despite weight recovery in newly diagnosed stricturing Crohn's disease: A case report.

Costa Beatriz Gabriela da BGD, Nobre Jeniffer Naomy JN, Yoshihara Ryan Nunes Yoshio RNY, Spiller Amanda Luísa AL et al.

Protein-energy malnutrition is a common complication in Crohn's disease (CD). In addition to weight loss, patients may develop significant alterations in body composition, including skeletal muscle depletion, which can negatively affect clinical outcomes and quality of life. Herein, we report on a patient with newly diagnosed CD who presented with severe malnutrition and myopenia, which persisted despite improvements in nutritional intake and body weight. A 27-year-old woman was admitted with abdominal pain, decreased appetite, nausea, vomiting, and progressive weight loss (10 kg, 22% of her usual body weight). Based on clinical presentation, family history, and magnetic resonance enterography findings, stricturing CD was diagnosed. Nutritional assessment revealed severe malnutrition (body weight, 31 kg; body mass index, 12.26 kg/m2; phase angle, 4.4°, intracellular-to-extracellular mass ratio, 0.75). Computed tomography-based body composition analysis demonstrated marked skeletal muscle depletion (skeletal muscle index, 27.5 cm2/m2), confirming myopenia. The patient was treated with corticosteroids, infliximab, azathioprine, and multidisciplinary nutritional management. After 12 months of follow-up, she achieved clinical remission and gained approximately 25% of her initial body weight. Despite significant weight recovery and improved dietary intake, computed tomography (CT) revealed low skeletal muscle mass and increased visceral and subcutaneous adipose tissue, indicating persistent myopenia. This case highlights the importance of comprehensive body composition assessments in CD. Clinical remission and weight gain may not accurately reflect recovery of skeletal muscle mass. Early nutritional evaluation and longitudinal body composition monitoring may be helpful in the management of patients with CD to identify persistent muscle depletion and optimize long-term outcomes.

PMID 42872489
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PubMedArrhythmia & electrophysiology review2026-10-13

Management of Post-heart Transplant Atrial Fibrillation.

Abdou Merna M, Sifuentes Aaron A AA, Goldar Ghazaleh G, Lee Ran R et al.

AF is the most common atrial arrhythmia encountered after orthotopic heart transplantation, with distinct pathophysiology and clinical implications. While early postoperative AF is typically transient, late-onset AF is increasingly recognised as a marker of graft dysfunction, rejection or vasculopathy. Risk factors include advanced recipient age, prolonged ischaemic time and immunosuppressive therapy. The denervated status of the transplanted heart alters typical electrophysiology, complicating diagnosis and management. Management requires individualised strategies balancing rate versus rhythm control, careful drug interaction monitoring and thromboembolic risk assessment. Emerging evidence supports catheter ablation in select cases, although data remain limited. Immunosuppressants, particularly calcineurin inhibitors and azathioprine, may increase AF susceptibility. Given the lack of transplant-specific AF guidelines, a multidisciplinary approach is essential. Improved understanding of AF in orthotopic heart transplantation is critical to optimising graft longevity and patient survival. Future studies are needed to guide evidence-based management and surveillance.

PMID 42866112
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PubMedFrontiers in immunology2026-10-13

Case Report: Efgartigimod in refractory non-tumor Lambert-Eaton myasthenic syndrome.

Baltasar-Corral Ana A, García-Barragán Nuria N, Zarza-Sanz Beatriz B, Buisán-Catevilla Francisco Javier FJ et al.

Lambert-Eaton myasthenic syndrome (LEMS) is a rare autoimmune disorder, associated with neoplastic disease in 50-60% of cases. In severe cases, currently available immunomodulatory therapies frequently fail to achieve adequate control. We report a 20-year-old woman with non-tumor LEMS refractory to 3,4-diaminopyridine, sequential immunosuppression with prednisone, azathioprine, mycophenolate mofetil and rituximab and plasma exchange, who remained severely disabled after two years of progressive disease. Off-label efgartigimod (1000mg subcutaneously weekly for four weeks, with the interval between cycles initially adjusted according to symptom recurrence), produced rapid and sustained clinical improvement, including recovery from a respiratory decompensation episode. The Myasthenia Gravis Activities of Daily Living (MG-ADL) score decreased from a baseline of 5-9 to a minimum of 2, and the Quantitative Myasthenia Gravis (QMG) score improved from 13-18 to 8-11. Symptoms consistently recurred toward the end of the third week of each treatment-free interval, prompting a fixed two-week interval, which stabilized clinical response and reduced fluctuation severity. This is, to our knowledge, the first report of sustained clinical benefit from FcRn inhibition in non-paraneoplastic, long-standing refractory LEMS. As in myasthenia gravis, LEMS is mediated by pathogenic circulating IgG antibodies, and these findings support FcRn inhibition as a rational treatment strategy in refractory LEMS regardless of tumor association.

PMID 42865796
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PubMedGut and liver2026-10-12

Autoimmune Hepatitis: 2026 Update.

Abe Kazumichi K, Tanaka Atsushi A

Autoimmune hepatitis (AIH) is an autoimmune liver disease characterized by immune-mediated hepatocellular destruction. This review provides a comprehensive update on the changes in the clinical landscape of and advancements in therapy for AIH up to 2026. Recent epidemiological data indicate a significant increase in both the incidence and prevalence of AIH worldwide, emphasizing potential shifts in environmental triggers and heightened disease awareness. Diagnosing AIH remains intricate owing to atypical manifestations; however, the newly updated 2025 European Association for the Study of the Liver clinical practice guidelines introduce refined simplified diagnostic criteria that incorporate contemporary laboratory platforms and international pathology standards to enhance real-world sensitivity. Immunosuppressive therapy continues to be the cornerstone of management. Corticosteroids remain the standard first-line treatment, while the upfront combination of prednisolone and mycophenolate mofetil is increasingly recommended alongside conventional azathioprine regimens. Achieving a complete biochemical response-defined as the normalization of transaminases and immunoglobulin G within 6 to 12 months-has emerged as a powerful, universally recognized surrogate endpoint for long-term prognosis, strongly predicting lower liver-related mortality and transplantation rates across both Western and Asian cohorts. Furthermore, this review addresses complex clinical entities, including drug-induced autoimmune-like hepatitis secondary to novel immunotherapies or vaccinations, and the phenotypic continuum of the primary biliary cholangitis-AIH overlap syndrome. Finally, we highlight the clinical utility of emerging, highly specific diagnostic biomarkers, such as anti-docking protein 2 antibodies-a promising candidate for seronegative cases, pending external multicenter validation-and outline essential directions for future AIH research.

PMID 42860919
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