{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T13:50:34Z","timestamp":1775224234718,"version":"3.50.1"},"reference-count":25,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T00:00:00Z","timestamp":1769558400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T00:00:00Z","timestamp":1769558400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1TR002553"],"award-info":[{"award-number":["UL1TR002553"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Muscle and Nerve"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction\/Aims<\/jats:title>\n                    <jats:p>Azathioprine (AZA) is a first\u2010line immunosuppressive agent for myasthenia gravis (MG), yet most toxicity data for AZA are from gastrointestinal literature. The aim of the current study is to add a large MG patient cohort with a comprehensive evaluation of the adverse event profile of AZA and associations between patient demographics and drug reactions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients were identified from the Duke Electronic Medical Record using EPIC's SlicerDicer tool. Inclusion criteria: MG diagnosis confirmed by antibody\/electrodiagnostic testing, evaluation by a Duke neuromuscular physician, and AZA use between January 1, 2014 and January 7, 2023. Drug reaction was defined as an abnormal lab result or symptomatic side effect after AZA initiation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 145 patients, 96 (66%) developed a drug reaction; 63 (43.5%) required AZA dose reduction or discontinuation, and 23 (16%) had symptomatic side effects. Most reactions improved with dose reduction or observation. Leukopenia, macrocytosis, and hepatotoxicity were the most frequent. For every additional comorbidity, the odds of drug reaction increased by 30% (OR 1.3; 95% CI 1.12\u20131.51;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Flu\u2010like reactions occurred in 10% of patients. Cancer incidence (4.1%) was rare and there were no cases of Pneumocystis jirovecii pneumonia despite rare use of trimethoprim\u2010sulfamethoxazole prophylaxis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>AZA drug reactions were common but infrequently severe or symptomatic. Higher comorbidity burden predicted drug reactions. Most laboratory abnormalities resolved without AZA discontinuation, supporting individualized monitoring and dose adjustment rather than automatic cessation. Lower doses should be considered for balancing efficacy with dose\u2010dependent drug reactions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mus.70165","type":"journal-article","created":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T13:06:31Z","timestamp":1769605591000},"page":"788-793","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Azathioprine Toxicity in Patients With Myasthenia Gravis: A Single Center Experience"],"prefix":"10.1002","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3641-8778","authenticated-orcid":false,"given":"Rahul","family":"Gaini","sequence":"first","affiliation":[{"name":"Department of Neurology Duke University  Durham North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tracy","family":"Truong","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics Duke University  Durham North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Morena","sequence":"additional","affiliation":[{"name":"Department of Neurology Duke University  Durham North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,1,28]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v19.i11.1699"},{"issue":"7","key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1002\/jgh3.12955","article-title":"Long\u2010Term Safety and Effectiveness of Azathioprine in the Management of Inflammatory Bowel Disease: A Real\u2010World Experience","volume":"7","author":"Yewale R. V.","year":"2023","journal-title":"JGH Open: An Open Access Journal of Gastroenterology and Hepatology"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.1989.119"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.3390\/jpm11080778"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.59.4671"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000002790"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.38.2.258"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/CND.0000000000000133"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.36.1.35"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(24)00028-0"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(24)00180-7"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"issue":"1","key":"e_1_2_11_14_1","first-page":"5","article-title":"Malakoplakia and Immunosuppressive Therapy. Reversal of Clinical and Leukocyte Abnormalities After Withdrawal of Prednisone and Azathioprine","volume":"119","author":"Biggar W. D.","year":"1985","journal-title":"American Journal of Pathology"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.36.11.1533"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s001150050132"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.27481"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2133.2011.10575.x"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.12329"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2021.03.015"},{"key":"e_1_2_11_21_1","unstructured":"Centers for Disease Control and Prevention \u201cUSCS Data Visualizations: Cancer Incidence \u2013 United States Cancer Statistics \u201dU.S. Department of Health & Human Services retrieved September 29 2025 https:\/\/gis.cdc.gov\/Cancer\/USCS\/."},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.34479"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djab131"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2015.1187"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ncl.2018.01.011"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-024-07368-0"}],"container-title":["Muscle &amp; Nerve"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mus.70165","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/mus.70165","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mus.70165","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T13:02:44Z","timestamp":1775221364000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/mus.70165"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,28]]},"references-count":25,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1002\/mus.70165"],"URL":"https:\/\/doi.org\/10.1002\/mus.70165","archive":["Portico"],"relation":{},"ISSN":["0148-639X","1097-4598"],"issn-type":[{"value":"0148-639X","type":"print"},{"value":"1097-4598","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,28]]},"assertion":[{"value":"2025-06-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}