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Vol. 69. Issue 5.
Pages 260-267 (September - October 2018)
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Vol. 69. Issue 5.
Pages 260-267 (September - October 2018)
Original article
Azathioprine Reduces the Risk of Audiometric Relapse in Immune-mediated Hearing Loss
La azatioprina reduce el riesgo de recaída audiométrica en hipoacusia inmunomediada
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Nieves Mata-Castroa,
Corresponding author
nmata@cirujanoscyc.com

Corresponding author.
, Javier Gavilanes-Plasenciab, Rafael Ramírez-Camachoc, Alfredo García-Fernándezb, José Ramón García-Berrocalc
a Servicio de Otorrinolaringología, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
b Servicio de Otorrinolaringología, Hospital Universitario 12 de Octubre, Madrid, Spain
c Servicio de Otorrinolaringología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
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Tables (4)
Table 1. Demographic Data of the 20 Patients With Immune-mediated Hearing Loss Treated With Azathioprine Over 12 Months.
Table 2. Mean Audiometric Relapse-free Survival (in Months) of the Patients With Immune-mediated Hearing Loss Treated With Azathioprine.
Table 3. Recruitment of Patients per Year in Immune-mediated Hearing Loss Studies.
Table 4. Cox's Model of Proportional Risk to Analyse the Effect of the Age, Sex and Absence of Systemic Disease Variables on the Likelihood of Relapse.
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Abstract
Introduction

Current schemes for treatment of immune-mediated hearing loss with sporadic short-course, low-dose corticosteroids, are insufficient.

Methods

To determine the role of azathioprine in the control of auditory impairment, a longitudinal, observational, descriptive study was performed with 20 patients treated with azathioprine (1.5–2.5mg/kg/day into two doses) for 1 year. The loss of 10dB on two consecutive frequencies or 15dB on an isolated frequency was considered as relapse.

Results

The mean age of the patients was 52.50 years (95% CI: 46.91–58.17), half were women. Bilateral affectation was 65%. 75% had organ specific disease and 25% had systemic autoimmune disease. The difference between baseline PTA (46.49dB; DS 18.90) and PTA at 12 months (45.47dB; DS 18.88) did not reach statistical significance (P=.799). There was a moderate positive correlation between female sex and the presence of systemic disease (R=.577). By applying Student's t for paired data, a significant difference (P=.042) was obtained between the PTA in frequencies up to 1000Hz (PTA 125–1000Hz). The relative incidence rate of relapse per year was .52relapses/year (95% CI: .19–1.14]). The median time to audiometric relapse-free was 9.70 months (DS 1.03).

Conclusions

Azathioprine maintains the hearing threshold, decreases the risk of relapse, and slows down the rate at which patients relapse, altering the course of immune-mediated inner ear disease.

Keywords:
Autoimmune disease
Sensorineural hearing loss
Recurrence
Survival analysis
Resumen
Introducción

Los esquemas actuales de tratamiento de la hipoacusia inmunomediada con corticoides, a dosis baja y pauta corta, son insuficientes.

Métodos

Para determinar el papel de la azatioprina en el control del deterioro auditivo se ha llevado a cabo un estudio observacional descriptivo longitudinal con 20 pacientes tratados con azatioprina por vía oral (1,5-2,5mg/kg/día en dos dosis) durante 1 año. Se consideró recaída la pérdida de 10dB en dos frecuencias consecutivas o de 15dB en una frecuencia aislada.

Resultados

La edad media de los pacientes fue de 5250 años (IC 95%: 46,91-58,17), y la mitad fueron mujeres. La afectación bilateral fue del 65%. Un 75% presentaban enfermedad organoespecífica y un 25%, enfermedad autoinmune sistémica. La diferencia entre la PTA basal (46,49dB; DE 18,90) y la PTA a los 12 meses (45,47dB; DE 18,88) no alcanzó significación estadística (p=0,799). Existía una correlación positiva moderada entre sexo femenino y presencia de enfermedad sistémica (R=0,577). Aplicando t de Student para datos apareados se obtuvo una diferencia significativa (p=0,042) entre el descenso de la PTA en frecuencias hasta 1.000Hz (PTA 125-1.000Hz). La tasa relativa de incidencia de recaída por año fue de 0,52 recaídas/año (IC 95%: 0,19-1,14). El tiempo medio de supervivencia libre de recaída audiométrica fue de 9,70 meses (DE 1,03).

Conclusiones

La azatioprina mantiene el umbral de audición, disminuye el riesgo de recaída y frena la velocidad con la que los pacientes recaen, alterando el curso de la enfermedad inmunomediada del oído interno.

Palabras clave:
Enfermedad autoinmune
Hipoacusia neurosensorial
Recaída
Análisis de supervivencia

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