The development of the thiopurines in the 1950s ushered in a new group of immunosuppresive agents, the most important of them being azathioprine. It is inactive until it is metabolized in the liver and takes three to four weeks to be effective. The metabolites work by inhibiting DNA synthesis in dividing cells (such as activated lymphocytes). Like many other drugs, it has side effects, mainly in bone marrow toxicity, and long-term use eventually results in granulocytopenia and thrombocytopenia.
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