The therapeutic arsenal in the disease-modifying therapy of Multiple Sclerosis (MS), especially in its relapsing-remitting form, is becoming richer, particulary with new oral medications. In many countries, azathioprine is still used as a first-line treatment for MS, mainly for its low cost, but also for its tolerance and its effectiveness.
Report the experience of the neurology department of the University Hospital in Fez in the management of multiple sclerosis by the use of Azathioprine as first line disease-modifying therapy.
Retrospective study collecting 78 patients followed in the neurology department of Hassan II UHC of Fez for MS and who were treated with Azathioprine, from 2010 until May 2020.
Since 2010, a total of 78 MS patients followed in the Neurology department have been receiving Azathioprine as a disease-modifying therapy. The average age of the patients was 44 years, predominantly female. 83% of patients had relapsing-remitting MS while 17% had a progressive form. The duration of treatment varies between 1and 10 years. The mean EDSS at starting Azathioprine was 3.5. Hematological complications was noted in 14 %, such as lymphopenia in 7 cases, neutropenia in 2 cases, and pancytopenia in 2 cases. Only one patient, after 3 years of treatment with azathioprine, developed a serious adverse event "Macrophage activation syndrome". One patient presented with a moderate disturbance of the hepatic balance and another presented banal digestive disorders. Only 3 cases changed their disease-modifying therapy because of the side effects. The progress of patients taking Azathioprine was marked by clinical and radiological stability in 76%, while 14% developed relapses and 10% progressed. Therapeutic escalation was towards Rituximab for 9 patients and cyclophosphamide for 1 case.
Azathioprine is an appropriate treatment for MS, and a good alternative in low-income countries. But its use requires vigilance to avoid complications including the long-term risk of malignancy.