azathioprine / Generic mfg. - LARVOL DELTA

Second TNFi Therapy Versus Alternative Biologic Therapy in Patients With Inflammatory Bowel Disease and Previous TNFi Exposure and the Risk of Incident Immune-Mediated Inflammatory Diseases: A Real-World Cohort Study (ACG 2025) - "The impact of exposure to a second TNFi or switching to a biologic therapy with a different mechanism of action on the risk of IMIDs is unknown. Using the TriNetX US Collaborative Network (2014-2023), we identified adults with Crohn's disease (CD) or ulcerative colitis (UC) with previous exposure to infliximab or adalimumab who were either switched to a second TNFi or ustekinumab/vedolizumab. Among 14,770 patients, 6129 (41.5%) received a second TNFi (mean age 34.4 +/- 16.7, 49.6% female, 73.9% White, 80% CD) and 8641 (58.5%) were switched to ustekinumab or vedolizumab (mean age 39.7 +/- 17, 51.3% female, 75.3% White, 77.3% CD). Mean follow-up after the switch was 1354 and 1316 days, respectively. After PSM, the TNFi cohort had a higher risk of IMID compared to the control cohort (10.8% vs 6.9%, adjusted hazard ratio [aHR] 1.57, 95 % CI 1.37–1.79; log rank p< 0.0001)."

Clinical • Real-world • Real-world evidence • Ankylosing Spondylitis • Crohn's disease • Dermatology • Gastroenterology • Gastrointestinal Disorder • Hepatology • Immunology • Inflammation • Inflammatory Arthritis • Inflammatory Bowel Disease • Nicotine Addiction • Psoriasis • Rheumatoid Arthritis • Rheumatology • Seronegative Spondyloarthropathies • Ulcerative Colitis

Immunoglobulin G4 Smoldering Multiple Myeloma With Immunoglobulin G4-Related Autoimmune Hepatitis: A Rare Case Report. (PubMed, Immun Inflamm Dis) - "This article explores the clinical features and diagnostic challenges of IgG4 SMM coexisting with IgG4-AIH. IgG4 type SMM needs to be identified with IgG4-RD. Clinicians should pay attention to IgG subtype detection and clonal plasma cell analysis."

Journal • Autoimmune Hepatitis • Hematological Disorders • Hematological Malignancies • Hepatology • Immunology • Inflammation • Multiple Myeloma • Oncology • Primary Biliary Cholangitis • Smoldering Multiple Myeloma • Solid Tumor

Intestinal Transplantation in Crohn's Disease: A Case of Recurrent Disease and Secondary Allograft Failure (ACG 2025) - "Underlying CD remains refractory to multiple medical therapies, including sulfasalazine, azathioprine, corticosteroids, infliximab, adalimumab, and certolizumab...Vedolizumab is initiated to stabilize his disease and prevent further strictures...Existing diagnostics lack the specificity needed for accurate differentiation. A more precise approach incorporating integrated molecular diagnostics and bioinformatics is necessary to better understand the underlying mechanisms of post-transplant gut inflammation."

Clinical • CNS Disorders • Crohn's disease • Cytomegalovirus Infection • Fibrosis • Gastroenterology • Gastrointestinal Disorder • Hepatology • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • Liver Failure • Short Bowel Syndrome • Transplant Rejection • Transplantation • Vascular Neurology

A Wolf in Sheep's Clothing: A Rare Presentation of Colonic MALT Lymphoma in the Setting of Poorly Controlled Ulcerative Colitis (ACG 2025) - "She had failed multiple 5-ASA products, azathioprine, in addition to vedolizumab and was steroid dependent for two years...Adalimumab was discontinued and rituximab was initiated...H&E sections of a sigmoid biopsy showing a diffuse lymphoplasmacytic infiltrate involving the lamina propria and extending into the muscularis propria composed of small, mature lymphocytes with round nuclei and scant cytoplasm as well as numerous plasma cellsFigure: Figure 2. Immunohistochemical stains of a sigmoid biopsy showing CD20 positivity with co-expression of BCL2"

IO biomarker • B Cell Lymphoma • Colon Cancer • Colorectal Cancer • Extranodal Marginal Zone Lymphoma • Gastroenterology • Gastrointestinal Disorder • Hematological Malignancies • Immunology • Infectious Disease • Inflammatory Bowel Disease • Lymphoma • Marginal Zone Lymphoma • Non-Hodgkin’s Lymphoma • Solid Tumor • Ulcerative Colitis • BCL2 • CD20

Advances in mechanistic investigation and treatment of steroid-refractory ICI-induced liver injury. (PubMed, Clin Exp Med) - "Recent advancements in therapeutic research have identified promising second-line treatments, including immunosuppressants (tacrolimus, cyclosporine A, mycophenolate mofetil, and azathioprine), monoclonal antibodies (infliximab and tocilizumab), anti-thymocyte globulin, intravenous immunoglobulin, ursodeoxycholic acid for cholestatic cases, and blood purification techniques. Furthermore, we discuss the development of novel therapies informed by evolving insights into the condition's pathogenesis and the feasibility of reintroducing ICIs after ICI-DILI resolution. These advancements mark significant progress in optimizing patient outcomes and advancing the mechanistic understanding of ICI-DILI."

IO biomarker • Journal • Review • Hepatology • Liver Failure • Oncology • ABCB1 • PD-L1 • PD-L2

Reduced Intensity Transplantation for Severe Sickle Cell Disease (clinicaltrials.gov) - P2 | N=40 | Suspended | Sponsor: St. Jude Children's Research Hospital | Trial completion date: Aug 2027 ➔ Aug 2029

Trial completion date • Genetic Disorders • Hematological Disorders • Sickle Cell Disease • Transplantation

Vedolizumab as a Second Line Biologic for Cronkhite-Canada Syndrome (ACG 2025) - "She started infliximab (IFX) and azathioprine (AZA) in 10/2020 with resolution of her clinical symptoms, normalization of her calprotectin, and substantially improved but had incomplete response on repeated endoscopic and histologic evaluations...She started oral prednisone and initiated VDZ 11/2024...October 2024: IFX dose 10mg/kg, IFX level 14.1ug/mL, and IFX Ab <20ng/mL. March 2025: VDZ 300mg, VDZ level 27.4mcg/mL, VDZ Ab <9.8ng/mL.IFX: infliximab, Ab: antibody, VDZ: vedolizumab."

Clinical • Gastrointestinal Disorder

Mistaken for Infection: Delayed Recognition of Pyoderma Gangrenosum in a Crohn's Flare (ACG 2025) - "Azathioprine was discontinued, and IV methylprednisolone (40 mg daily) was started for a severe Crohn's flare.General surgery was consulted early and performed multiple drainages of the thigh lesion, but the wound continued to enlarge and remained painful despite broad-spectrum antibiotics (cefepime and daptomycin). Treatment includes corticosteroids, immunosuppressants, or biologics. In this case, steroids and vedolizumab led to near-complete resolution, highlighting the need for early diagnosis.Figure: Pyoderma Gangrenosum Lesions"

Crohn's disease • Dermatology • Gastroenterology • Gastrointestinal Disorder • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • Pyoderma Gangrenosum • Ulcerative Colitis

Acute Fibrostenotic and Fistulizing Ileal Crohn's Disease: Timing of Biologic Therapy in the Setting of Obstruction and Infection (ACG 2025) - "However, acute complications such as obstruction or suspected infection may delay therapy, complicating management.Case Description/ A 30-year-old biologic-naïve female with stricturing ileal CD diagnosed in 2020 (baseline fecal calprotectin 5,000 μg/g) presented with worsening abdominal pain while on prednisone 40 mg daily pending biologic approval...TPMT testing confirmed normal metabolism.Vedolizumab was denied by insurance. Given suspicion for evolving fistulizing disease, infliximab with azathioprine was selected...When infection or obstruction precludes immediate therapy, a cautious, coordinated approach allows for stabilization and optimized treatment outcomes.Figure: • Multifocal ileal strictures over 15 cm of the ileum. Pre-stenotic bowel wall dilatation to 4 cm.Figure: Transition point is in the RLQ at the terminal ileum, demonstrating circumferential mural thickening & surrounding inflammatory changes."

Crohn's disease • Gastroenterology • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease

Immunosuppressant Management in Rheumatology Patients Undergoing Elective Total Shoulder Arthroplasty (clinicaltrials.gov) - P2 | N=80 | Not yet recruiting | Sponsor: NYU Langone Health

New P2 trial • Orthopedics • Rheumatology

Esophageal Carcinoma Management Following Liver Transplant (ACG 2025) - "100% had reduction in calcineurin (7/7), 33% in prednisone (1/3), 66% in mycophenolate mofetil (2/3), 0% in everolimus (0/2), and 100% in azathioprine (1/1)...5 were treated with chemoradiation of carboplatin-paclitaxel (2), FOLFOX (2), docetaxel-cisplatin and fluorouracil (1)... Eight patients were diagnosed with esophageal carcinoma following liver transplantation. Average age 66 years, 25% female; 3 were managed surgically and 5 managed medically. Reduction in immunosuppression occurred in 75% of patients."

Anorexia • Barrett Esophagus • Esophageal Cancer • Gastrointestinal Disorder • Graft versus Host Disease • Hepatitis C • Hepatocellular Cancer • Hepatology • Immunology • Infectious Disease • Metabolic Dysfunction-Associated Steatohepatitis • Mucositis • Nephrology • Oncology • Solid Tumor • Squamous Cell Carcinoma • Transplant Rejection • Transplantation

In the Blink of an Eye: An Uncommon IBD Extra-Intestinal Manifestation of Panuveitis (ACG 2025) - "The patient's symptoms improved on steroids and vedolizumab induction...The patient reached clinical remission in the setting of infliximab infusions, methotrexate (MTX), azathioprine and oral steroids...Figure: Measurements of macular thickness, reflective of retinal inflammation. Both eyes show increased macular thickness suggestive of retinitis."

Crohn's disease • Dermatology • Gastroenterology • Gastrointestinal Disorder • Genetic Disorders • Immunology • Inflammation • Inflammatory Bowel Disease • Ocular Inflammation • Ophthalmology • Retinal Disorders • Scleritis • Uveitis

Vedolizumab for Ulcerative Colitis After Treatment of Isolated Rectal Diffuse Large B-Cell Lymphoma (ACG 2025) - "We present a rare case of a patient with Ulcerative Colitis (UC) presenting with refractory symptoms, found to have primary rectal DLBCL.Case Description/ This is a 50-year-old male with UC who presented to his gastroenterologist with ongoing bloody diarrhea despite an escalating regimen including adalimumab, azathioprine, and prednisone...He was treated with R-CHOP (combination chemotherapy including rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) which led to remission of both his DLBCL and UC...This case exemplifies the rare possibility of primary rectal DLBCL in an IBD patient on immunomodulator therapy and the importance of endoscopy to evaluate persistent symptoms despite standard therapy. Furthermore, this case supports other literature suggesting the safety of biologic therapy following successful GI lymphoma treatment."

B Cell Lymphoma • Colorectal Cancer • Diffuse Large B Cell Lymphoma • Gastroenterology • Gastrointestinal Disorder • Hematological Malignancies • Immunology • Inflammatory Bowel Disease • Lymphoma • Marginal Zone Lymphoma • Non-Hodgkin’s Lymphoma • Solid Tumor • Ulcerative Colitis

Refractory Collagenous Colitis Requiring Inpatient Infliximab Infusion (ACG 2025) - "Multiple therapies, including loperamide, diphenoxylate-atropine, budesonide, bismuth subsalicylate, cholestyramine, colesevelam, mesalamine, gluten-free diet, and recent initiation of prednisone with azathioprine for the current flare have been ineffective. Attempts to initiate outpatient biologic therapy, with infliximab or vedolizumab, were unsuccessful due to insurance denial...TPN was started and trials of octreotide and rifaximin yielded no improvement...Severity and chronicity of microscopic colitis may mimic that of inflammatory bowel disease, and biologic therapy such as TNF-α inhibitors may be used for treatment, although current knowledge is based on case reports and studies. Further research is needed to investigate the role, safety and efficacy of biologics for treating microscopic colitis, which may help streamline off-label treatments, decrease morbidity, improve barriers for initiating such medications and resource utilization."

Clinical • Cardiovascular • Celiac Disease • Gastroenterology • Gastrointestinal Disorder • Heart Failure • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • Renal Disease

Vedolizumab as an Effective Therapy in the Treatment of Cronkhite-Canada Syndrome Refractory to Standard Medical Therapy: A Case Report (ACG 2025) - "Treatment typically involves immunosuppressive therapy with corticosteroids, azathioprine, or infliximab...Initial treatment with prednisone and azathioprine was initiated, but azathioprine was discontinued due to worsening anemia...Given the rarity of CCS, randomized controlled trials are not feasible, and treatment decisions often rely on limited case reports, extrapolated data, and clinical judgment. Successful outcomes, as demonstrated here, underscore the importance of documenting and sharing such experiences to help inform future management strategies and improve patient care."

Case report • Clinical • Alopecia • Anemia • Colonic Polyps • Gastroenterology • Gastrointestinal Disorder • Glomerulonephritis • Immunology • Lupus Nephritis • Nephrology

Treatment of Rheumatoid Arthritis With DMARDs: Predictors of Response (clinicaltrials.gov) - P3 | N=400 | Recruiting | Sponsor: University of Nebraska | Trial completion date: Mar 2028 ➔ Mar 2029 | Trial primary completion date: Mar 2027 ➔ Mar 2028

Trial completion date • Trial primary completion date • Immunology • Inflammatory Arthritis • Rheumatoid Arthritis • Rheumatology

Management of Collagenous Colitis With Upadacitinib: Overcoming Diagnostic and Therapeutic Challenges (ACG 2025) - "Initial treatments included adalimumab, azathioprine, and vedolizumab, which provided minimal symptom relief and did not result in complete healing. Prednisone was temporarily effective, but long-term use was not feasible due to potential side effects.Due to the lack of sustained response to these treatments, off-label therapy with Upadacitinib was initiated...However, the pathophysiological overlap between microscopic colitis and IBD, particularly the role of dysregulated immune signaling, provides a rationale for JAK inhibition in refractory cases.Further studies are needed to establish the efficacy, safety, and optimal positioning of JAK inhibitors in the management of microscopic colitis.Figure: Figure 1: Images A,B,C: Normal colonoscopy 4 months after initiating UpadacitinibImage D: H&E, shows Normal colonic mucosa. Features of collagenous colitis no longer identifiedFigure: Figure 2 Image A: H&E, shows intraepithelial lymphocytesImage B: H&E, shows..."

Gastroenterology • Gastrointestinal Disorder • Immunology • Inflammation

Bridging the Gaps: Potential Inappropriate Treatment and Delay of Care in Sarcoidosis Patients on Steroid Monotherapy. (WASOG-AASOG 2025) - "We collected data on demographics, insurance type, steroid-related comorbidities (hypertension, diabetes, osteoporosis), and immunosuppressive medications, including glucocorticoids and SSAs (methotrexate, azathioprine, leflunomide, mycophenolate, hydroxychloroquine, infliximab, adalimumab). We identified 11,255 eligible patients. This work suggest that there are many patients may be inappropriately receiving steroid monotherapy, and that patients on steroid monotherapy may have delays in starting treatment. Sarcoidosis patients on steroid monotherapy are an important target for interventions to improve quality of care."

Clinical • Monotherapy • Cardiovascular • Diabetes • Hypertension • Immunology • Metabolic Disorders • Osteoporosis • Rheumatology • Sarcoidosis

A Review of Reports of Hepatic Failure and Hepatitis to the FDA Adverse Events Reporting System (FAERS) From Inflammatory Bowel Disease (IBD) Pharmacotherapy (ACG 2025) - "Reports of ADRs of all FDA approved IBD therapies including azathioprine, mercaptopurine, methotrexate, tacrolimus, balsalazide, mesalamine, osalazine, sulfasalazine, adalimumab, certolizumab pegol, golimumab, infliximab, natalizumab, vedolizumab, guselkumab, mirikixumab, risankizumab, ustekinumab, tofacitinib, upadacitinib, etrasimod, and ozanimod were reviewed. Tables 1 and 2 below show a truncated list of the reviewed medications, portraying significant ROR in ADR related to hepatitis or hepatic failure.There were 218 reports of hepatitis, and 135 reports of hepatic failure identified in patients with CD and UC. Azathioprine (ROR 4.26), mercaptopurine (ROR 3.08), and methotrexate (ROR 2.58) showed significant ROR for hepatitis in CD. Mercaptopurine (ROR 3.34), tacrolimus (ROR 21.17), and infliximab (ROR 1.86) showed significant ROR for hepatic failure in CD."

Adverse events • Review • Crohn's disease • Gastroenterology • Gastrointestinal Disorder • Hepatology • Immunology • Inflammation • Inflammatory Bowel Disease • Liver Failure • Ulcerative Colitis • ROR1

Intestinal Perforation in an Ulcerative Colitis Patient Following Upadicitinib Initiation (ACG 2025) - "Introduction: The non-selective Janus-Kinase (JAK) inhibitor, tofacitinib, has been associated with bowel perforation in ulcerative colitis (UC) patients...After having failed or lost response to infliximab, azathioprine, vedolizumab, ozanimod, and ustekinumab, she started UPA with a significant improvement in fecal urgency and frequency of her bowel movements...After follow up, the UPA was discontinued, and she was initiated on adalimumab. Prior investigations of perforation during UPA use in IBD reflect that the occurrences are so rare, it is difficult to determine whether they represent a true safety concern...While rare, providers should consider discussing the risk of perforation in UC patients prior to initiation of UPA.Figure: A computed tomography (CT) scan with intravenous contrast shows peri-colonic inflammation about the mid-transverse colon with extraluminal gas and posterior wall penetration without a drainable fluid collection. This image was captured from..."

Clinical • Anemia • Crohn's disease • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Immunology • Inflammation • Inflammatory Bowel Disease • Ulcerative Colitis • CRP

Delays and Disparities in Glucocorticoid-Sparing Therapy in Sarcoidosis: Findings from A Tertiary Care Center (WASOG-AASOG 2025) - "GSAs included methotrexate, azathioprine, mycophenolate mofetil, leflunomide, hydroxychloroquine, adalimumab, and infliximab. Our study found substantial delays and heterogeneity in initiation of GSAs among patients with sarcoidosis seen at a tertiary care center. Notably, Black individuals experienced significantly longer times to treatment and GSA initiation than White individuals independent of demographic and disease characteristics, suggesting barriers and possible disparities in treatment access and/or clinical decision-making. Furthermore, patients with longer disease duration were less likely to initiate GSA therapy at any time point."

Immunology • Sarcoidosis

A Phase 2 Study of Rilonacept in Patients with Cardiac Sarcoidosis: Study Design (WASOG-AASOG 2025) - P2 | "Patients will be randomized 1:1 to receive either rilonacept (320 mg SC [loading dose] on day 1 followed by 160 mg SC weekly [maintenance dose]) added to standard therapy or non-biologic standard therapy (corticosteroids and steroid-sparing agents [e.g., azathioprine, methotrexate, mycophenolate, or leflunomide]) alone. REPAIR-CS will measure the efficacy of rilonacept added to standard therapy vs. non-biologic standard therapy alone in patients with CS, given the efficacy of rilonacept in certain diseases in which the IL-1 pathway is implicated."

Clinical • P2 data • Cardiovascular • Congestive Heart Failure • Heart Failure • Immunology • Infectious Disease • Sarcoidosis • CRP • IL1B

Challenges in Managing the Ocular Complications of Stevens-Johnson Syndrome in Patients with Co-Existent Auto-Immune Disease. (PubMed, Semin Ophthalmol) - "They were managed with systemic IMT, including corticosteroids, mycophenolate mofetil (MMF), azathioprine, intravenous immunoglobulin (IVIG), cyclophosphamide, and rituximab. Rituximab and MMF may provide long-term disease control, but discontinuation of IMT should be approached cautiously to prevent recurrence. Further research is needed to optimize treatment protocols and determine the ideal duration of systemic therapy in chronic ocular SJS."

Journal • Immunology • Inflammation • Ocular Inflammation • Rheumatology • Steven-Johnson Syndrome

Mesenteric Panniculitis, Tamoxifen, and Severe Necrotizing Pancreatitis (ACG 2025) - "Following a course of prednisone prescribed by GI, the patient was referred to hematology to rule out non-Hodgkin lymphoma and started on tamoxifen for persistent abdominal pain...Standard treatments involve steroids, tamoxifen and immunosuppressants such as azathioprine, rituximab, cyclophosphamide, infliximab, and methotrexate...High index of suspicion should be maintained for patients on Tamoxifen therapy regardless of duration of use for prompt recognition and management. Figure: Mesenteric PanniculitisFigure: Walled off pancreatic necrosis"

Breast Cancer • Dyslipidemia • Estrogen Receptor Positive Breast Cancer • Fibrosis • Hematological Malignancies • Hormone Receptor Breast Cancer • Hypertriglyceridemia • Immunology • Lipodystrophy • Lymphoma • Metabolic Disorders • Non-Hodgkin’s Lymphoma • Obesity • Pancreatitis • Solid Tumor

Successful Use of Rituximab in Refractory Autoimmune Hepatitis: A Case Report (ACG 2025) - "First-line therapy typically involves corticosteroids in combination with azathioprine, which induces remission in most patients...The patient was initiated on high dose corticosteroids with an initial favorable response and was started on cyclophosphamide for vasculitis management per Rheumatology recommendations...However, despite these encouraging findings, Rituximab has not yet received FDA approval for the treatment of AIH. Additional studies are necessary to further evaluate its efficacy and safety profile in this patient population and to support its integration into standard treatment protocols.Figure: Liver biopsy: Portal based plasma cell rich moderate chronic inflammation with interface hepatitis, moderate lobular inflammation , acidophil bodies and bridging fibrosis ( H&E stain; 200X magnification) Figure: Liver biopsy displaying fibrosis (Masson trichrome stain, 100X magnification)"

Case report • Clinical • ANCA Vasculitis • Autoimmune Hepatitis • Fibrosis • Hepatology • Immunology • Inflammation • Rheumatology • Vasculitis • CD20