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Luca Massacesi, MD; Alessandro Parigi, MD; Alessandro Barilaro, MD; Anna Maria Repice, MD; Gianni Pellicanò, MD; Angela Konze, MD; Gianfranco Siracusa, MD; Rosanna Taiuti, MD; Luigi Amaducci, MD

Arch Neurol. 2005;62:1843-1847.

Background  Azathioprine is an immunosuppressive agent that reduces relapse rates in patients with multiple sclerosis (MS), but its efficacy in suppressing new brain lesions has never been evaluated.

Objective  To evaluate the efficacy of azathioprine therapy on new brain lesion suppression in MS.

Design  Open-label treatment vs baseline study.

Setting  Outpatient MS clinical center at a university hospital.

Patients  Fourteen patients with relapsing-remitting MS of short duration and at least 3 gadolinium-enhancing (Gd+) brain lesions observed within 6 months before treatment.

Intervention  Azathioprine, up to 3 mg/kg daily, individually adjusted according to blood lymphocyte number and the occurrence of adverse events.

Main Outcome Measures  Brain Gd+ lesions evaluated by monthly magnetic resonance imaging for 6 months before and 6 months during treatment and new T2 lesions evaluated during the same periods and after an additional 6 months.

Results  The treatment reduced to 0 the median Gd+ lesion number and volume per magnetic resonance image (P<.001 for both), resulting in a Gd+ lesion number reduction of 50% or more in 12 of 14 patients (P<.01). An equivalent reduction in the new T2 lesion number was observed (P<.02); this activity also persisted during the additional treatment period evaluated using this outcome measure (P<.01). The median azathioprine dose administered (2.6-2.8 mg/kg daily) reduced the mean blood lymphocyte count to 57% of the baseline value. Adverse events were transient or reversible with dose adjustment.

Conclusions  This study indicates for the first time that azathioprine, administered at lymphocyte-suppressing doses, is effective in reducing MS new brain inflammatory lesions and is well tolerated.

Author Affiliations: Departments of Neurological and Psychiatric Sciences (Drs Massacesi, Parigi, Barilaro, Repice, Siracusa, Taiuti, and Amaducci) and Clinical Physiopathology (Drs Pellicanò and Konze), University of Florence, Florence, Italy.
Deceased.