Living with Lupus

Azathioprine (Imuran) as a Lupus Treatment

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What Is Imuran?

Azathioprine, sold under the brand name Imuran, is an immunosuppressant. Immunosuppressants are a class of medications that decrease the activity of the body’s immune system. Azathioprine is used with other medications to prevent transplant rejection in people who received kidney transplants. It is also used to treat severe rheumatoid arthritis when other medications and treatments have not helped.

While it is not approved for lupus, it is commonly used as a treatment for systemic lupus erythematosus and lupus nephritis. In a small survey of our Lupus Corner community, about 5% of people had been prescribed Imuran in order to treat their lupus. In fact, the survey showed that more people had tried Imuran than Benylsta, the most recent drug approved for lupus.

How Does It Work?

Azathioprine is a prodrug, a substance that is not an active drug itself but is activated in the body. In several steps, it is converted in the body to its active components 6-mercaptopurine and 6-thioinosinic acid. These components reduce the function of the body’s immune system by interfering with DNA synthesis, which is needed for cells to grow and divide. Although the immune system is important for fighting infections, immune system cells sometimes mistakenly attack the body’s own tissues, which is the case for the conditions Azathioprine is used to treat, such as lupus, IBD, and rheumatoid arthritis.


Azathioprine is generally used alongside prednisone and can reduce the amount steroids used to manage the disease. Several studies have shown Azathioprine to improve disease activity in severe lupus nephritis. A small study published in 1971 showed improved disease outcomes for SLE patients taking Azathioprine along with prednisone compared to patients taking prednisone by itself.

As you know, each person’s experience with lupus is unique, and Azathioprine is not an option for everyone. You should discuss with your doctor if Azathioprine may be a good treatment option for you.

Safety / Side Effects

The most common side effects of azathioprine are gastrointestinal, such as nausea, vomiting and diarrhea.

Some side effects can be serious. If you experience any of the following symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately.

  • rash
  • fever
  • weakness
  • muscle pain

This medication may cause other side effects. Call your doctor if you have any unusual problems while you are taking azathioprine.

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