Exacerbation of Systemic Lupus Erythematosus after Withdrawal of Azathioprine Therapy

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Abstract
In a controlled clinical trial of withdrawal of long-term azathioprine medication from nine patients with systemic lupus erythematosus, exacerbation of the disease occurred in seven of the nine. Only one of seven control patients continued on azathioprine therapy had exacerbation of the disease. Exacerbations were delayed (mean of 89 days after withdrawal) and were refractory to treatment. One patient died during an exacerbation that followed the discontinuation of azathioprine therapy. The difficulties encountered upon withdrawal of long-term azathioprine therapy and the unknown risk of long-term azathioprine administration necessitate careful reconsideration of the indications for use of this potent drug.