Long-term Efficacy and Safety of Azathioprine in Ulcerative Colitis

Abstract

AZA is a safe and effective therapy in UC patients who fail 5-aminosalisylates in both the short and long term. Escalation to a biologic therapy or colectomy was unlikely among patients who were able to continue AZA therapy beyond 5 years.

Low-dose azathioprine is effective in maintaining remission in steroid-dependent ulcerative colitis: results from a territory-wide Chinese population-based IBD registry

“…Being consistent with the results of a recent systematic review [Torres et al 2015], relapse rate in our cohort increased significantly after AZA withdrawal. The proportion of patients requiring escalation to biologics or surgery was around 5%, lower than that reported by studies in which patients maintained on standarddose AZA [Jharap et al 2010;Sood et al 2015].…”

Sustained Clinical Efficacy and Mucosal Healing of Thiopurine Maintenance Treatment in Ulcerative Colitis: A Real-Life Study

“…Evidence-based data supporting the efficacy of AZA and 6MP in UC are limited, and the main evidence comes from observational studies, mainly retrospective. Observational studies report substantial variability in effectiveness of thiopurines in UC, ranging from 40% to 70% [ 20 – 26 ]. However, significant heterogeneity across studies, methodological limitations, small sample size, variable length of follow-up, and different endpoint definitions highlight the uncertainty of the available data.…”

“…Although the main limitation of our study is its retrospective design, the large number of patients included and the consistent length of follow-up (760 person-years) are the main strengths. Moreover, we report data addressing MH in a large subgroup of patients, and this represents a peculiarity of our study because thiopurine-induced MH has not been extensively studied and it is usually not assessed in most observational studies [ 24 – 26 ]. Another strength of our study is the strict definition of steroid-free clinical remission, our primary endpoint, that is, the absence of diarrhea and blood in stools, without need of any escalation of therapy, including steroids, anti-TNF alpha agents, or surgery.…”

Experts Opinion on the Practical Use of Azathioprine and 6-Mercaptopurine in Inflammatory Bowel Disease

“…There were 164 (64.3%) of 255 patients who were still receiving AZA at the last follow-up, of whom 154 (60.4%) were considered to have achieved sustained clinical benefit. 55 Fraser reviewed the charts of patients attending the Oxford IBD clinic from 1968 to 1999. The overall remission rate under AZA-remission was defin e da sn on e e df o ro r a l steroids for at least 3 months and relapse as active disease requiring steroids-was 58% (n ¼ 346).…”