Table 2 Summary of studies and case reports identified by systemic literature search. We searched the Medline indexed literature after 1996 combining the words azathioprine, purpura, Schoenlein-Henoch and further searched the reference lists of identified articles for additional papers. We restricted results to English language published literature.
From: Azathioprine therapy for steroid-resistant Henoch-Schönlein purpura: a report of 6 cases
Author (year) | Number of patients | Reason for azathioprine use | Treatment used | Duration of study | Conclusions |
|---|---|---|---|---|---|
Bergstein (1998) [16] | 21 | Crescentic HSP nephritis | Azathioprine and steroids | 9–24 months and average follow up time of 32 months | Azathioprine is effective in reducing hematuria, proteinuria, serum creatinine and increasing creatine clearence in 19/21. Two patients progressed to ESKD |
Foster (2000) [17] | 17 | Severe HSP nephritis | Azathioprine and prednisone | Azathioprine 1–4 mg/kg and prednisone for 46.7 +/− 19 weeks compared to historical controls treated in various ways | No progression of renal lesions after treatment initiation. Favorable outcome compared to historical control group. |
Singh (2002) [18] | 9 | Severe HSP nephritis | Azathioprine and steroids | Azathioprine treatment of a mean of 14.7 months and steroids for 12.1 months, 4.7 years mean follow up | Mean resolution of proteinuria and hematuria 6.5 and 6.6 months respectively |
Shin (2005) [19] | 20 | Severe HSP nephritis | Azathioprine and steroids versus steroids alone | Azathioprine for 8 months, steroids median of 1.7 years, median follow up 4.8 years | Azathioprine and steroids ameliorate histopathological features and improve the clinical course of severe HSP nephritis. No significant differences in hematuria and proteinuria between the groups. |
Shenoy (2007) [20] | 27 | HSP nephritis grade IIIb or greater | Induction with steroids and CYC for 8–12 weeks followed by maintanance with azathioprine and steroids | Azathioprine for a mean of 12 months, 6.9 y mean follow up period, | 37 % complete recovery, 40.7 % persistent proteinuria, 7.4 proteinuria and HTN, 14.8 % ESKD. Poor outcome on those being older at presentation and having crescents/heavy proteinuria 6 months post-diagnosis |
Trapani (2010) [13] | 1 | Hemorrhagic bullous cutaneous involvement | Azathioprine 2.5 mg/kg with steroids | Follow up 5 months | Symptom resolution |
Ninchoji (2011) [21] | 32 | Moderate or severe HSP nephritis | Azathioprine 2 mg/kg, steroids and anticoagulants for modarate severe and severe nephritis in comparison to ACE-I or ARB for moderate severe nephritis | Combination therapy including azathioprine for 6 months | 90 % resolution of moderate HSP nephritis by 14.9 months and 90 % resolution of severe nephritis by 11.1 months |