Immunosuppressant May Help in Refractory Eczema

The immunosuppressant Imuran (azathioprine) may offer some relief to patients with eczema that is refractory to standard topical treatment, according to researchers here.
Twelve weeks of treatment with the drug resulted in modest but significant improvements in eczema symptoms and overall quality of life, reported Simon J. Meggitt, M.D., a dermatologist at the Royal Victoria Infirmary here, in the March 11 issue of The Lancet.
The parallel-group, double-blind, placebo-controlled trial included 63 patients with moderate-to-severe eczema not responding to topical steroid treatment. Two-thirds received Imuran and one-third placebo once-daily. Dosing of Imuran was based upon ability to metabolize the drug, as judged by measurements of the activity of the thiopurine methyltransferase enzyme.
At week 12, the treatment group had a 37% reduction of symptoms compared with 20% for the placebo group. This 17% difference was statistically significant (95% confidence interval=4%-29%).
Compared with placebo, the treatment group also had significant improvements in global assessment and quality of life scores as rated by patients (P=.05) and investigators (P=.01).
Although the difference in symptom reduction between the treatment and placebo groups was modest, the authors said, "in view of the significant improvements that were also seen in secondary outcome variables, we feel that overall azathioprine treatment does produce a clinically relevant change in eczema severity, in particular because quality of life and global response are thought to be meaningful indicators of change in eczema."
Adverse events were generally mild, with nausea the most commonly reported side effect, which necessitated dose reduction in seven individuals. Four participants could not tolerate even small doses and withdrew from the study. Drug hypersensitivity (fever and myalgia) occurred in two participants.
There was a wide variation among individuals in response to the drug, and its mechanism of action in atopic eczema is not known, the investigators said.
The results of this study warrant further investigation of Imuran for eczema and other inflammatory disease, they concluded.
In the United States, the drug is used to treat rheumatoid arthritis and to prevent rejection of kidneys after transplant. Off-label uses include treatment of inflammatory bowel disease and lupus erythematosus.