Does long term treatment with azathioprine predispose to malignancy and death in patients with systemic lupus erythematosus?(Letters)

The treatment of patients with rheumatic diseases with second line agents has expanded in the past three decades. However, such drugs have been linked with the development of malignancy, particularly in patients with rheumatoid arthritis. (1) Azathioprine is used to treat patients with systemic lupus erythematosus (SLE) with renal disease, of as a steroid-sparing agent. (2) We have assessed the risk that azathioprine treatment predisposes to the development of malignancies and death in patients with SLE.

We carefully reviewed the case notes of 358 patients with SLE receiving long term follow up in the Lupus Clinic at University College London, between 1978 and 2002, …