Dr's William Rae, Georgina Burke & Ashwin Pinto studied the breakdown of azathioprine in people with myasthenia gravis A completed myaware funded project, carried out in Southampton by Dr's William Rae, Georgina Burke and Ashwin Pinto, has been published in the Journal of Neuroimmunology (2016) 293: 82-85. This is a study that analyses the breakdown products (metabolites) of azathioprine in the blood of patients with myasthenia gravis (MG). Patients with troublesome symptoms of autoimmune myasthenia gravis are typically treated with medication that suppresses the immune system. Most patients take a combination of prednisolone (steroids) and other medications, known as steroid-sparing agents. The most commonly prescribed steroid-sparing agent for treatment of myasthenia is azathioprine and the dose given is typically calculated according to the patient's weight. Recently, new biochemical blood tests have been developed to monitor patients on azathioprine and help to predict whether patients are on the correct dosage of azathioprine. Dr Pinto and colleagues studied 19 patients who had been taking azathioprine for over one year and found that new metabolite tests were helpful in adjusting the dose if patients had abnormal routine blood tests or suffered with frequent infections. In addition, some of the patients did not appear to benefit from azathioprine at the standard dose and the tests could help to decide whether an increase in dose would be effective for these patients. The results were also presented at the Specialist Interest Myasthenia Group at the Association of British Neurologists' meeting in May 2016, and was very well received.