| Autor: |
Grzechocińska J; First Department of Cardiology, Medical University of Warsaw, 1a Banacha St., 02-097 Warsaw, Poland., Tymińska A; First Department of Cardiology, Medical University of Warsaw, 1a Banacha St., 02-097 Warsaw, Poland., Giordani AS; Cardiology, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35-100 Padova, Italy., Wysińska J; First Department of Cardiology, Medical University of Warsaw, 1a Banacha St., 02-097 Warsaw, Poland., Ostrowska E; First Department of Cardiology, Medical University of Warsaw, 1a Banacha St., 02-097 Warsaw, Poland., Baritussio A; Cardiology, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35-100 Padova, Italy., Caforio ALP; Cardiology, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35-100 Padova, Italy., Grabowski M; First Department of Cardiology, Medical University of Warsaw, 1a Banacha St., 02-097 Warsaw, Poland., Marcolongo R; Cardiology, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35-100 Padova, Italy., Ozierański K; First Department of Cardiology, Medical University of Warsaw, 1a Banacha St., 02-097 Warsaw, Poland. |
| Abstrakt: |
The use of immunosuppressive therapy (IT) in biopsy-proven, autoimmune/immune-mediated (AI), virus-negative myocarditis has become the standard of care. In particular, according to recent guidelines, azathioprine (AZA), in association with steroids, is a cornerstone of first-line therapy regimens. IT may have a crucial impact on the natural history of AI myocarditis, preventing its progression to end-stage heart failure, cardiovascular death, or heart transplantation, provided that strict appropriateness and safety criteria are observed. In particular, AZA treatment for AI virus-negative myocarditis requires the consideration of some crucial aspects regarding its pharmacokinetics and pharmacodynamics, as well as a high index of suspicion to detect its overt and/or subclinical side effects. Importantly, besides a tight teamwork with a clinical immunologist/immuno-rheumatologist, before starting IT, it is also necessary to carry out a careful "safety check-list" in order to rule out possible contraindications to IT and minimize patient's risk. The aim of this review is to describe the pharmacological properties of AZA, as well as to discuss practical aspects of its clinical use, in the light of existing evidence, with particular regard to the new field of cardioimmunology. |
