Rapid Communication
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Dec 7, 2006; 12(45): 7332-7336
Published online Dec 7, 2006. doi: 10.3748/wjg.v12.i45.7332
Long term results of use of azathioprine in patients with ulcerative colitis in India
Ajit Sood, Vandana Midha, Neena Sood, Manu Bansal
Ajit Sood, Departments of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India
Vandana Midha, Manu Bansal, Departments of Medicine, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India
Neena Sood, Departments of Pathology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India
Correspondence to: Professor Ajit Sood, Department of gastroenterology, Dayanand Medical College and Hospital, Ludhiana 141001, India. ajitsood10@sify.com
Telephone: +91-161-2301749 Fax: +91-161-2300791
Received: September 1, 2006
Revised: September 28, 2006
Accepted: October 24, 2006
Published online: December 7, 2006
Abstract

AIM: To evaluate the role of azathioprine (AZA) in Indian patients with ulcerative colitis over longer duration of time.

METHODS: One hundred fifty six patients with ulcerative colitis who were treated with AZA from January 1995 to December 2003 were reviewed. The indications for its use were as follows: (1) steroid dependent and steroid refractory disease; (2) Azathioprine monotherapy for naïve patients with severe disease; and (3) combination therapy (AZA + sulfasalazine or 5-aminosalicylates) for naïve patients with severe disease. The data included patient and disease demographics, efficacy and toxicity profile of AZA. Patients with a minimum duration of 6 mo use of AZA were included in this report.

RESULTS: Of a total of 156 patients treated with AZA, 45 were excluded from analysis for the following reasons- (follow up less than 6 mo, n = 9; poor follow up, n = 18; adverse affects, n = 18). In steroid refractory/dependent group the mean number of relapses prior to and post initiation of AZA therapy were 3.28 (± 0.81) and 0.94 (± 0.29) respectively. Discontinuation of steroids could be accomplished in 12 of the 15 steroid dependent patients. The proportion of patients with sustained remission of 1, 2, 3, 4 and 5 years duration were calculated. Eighteen patients experienced adverse effects necessitating withdrawal of AZA (pancreatitis, n = 7; hepatitis, n = 3; gastrointestinal intolerance, n = 2; alopecia, n = 2; and hematological, n = 4) while 13 patients needed dose reduction or temporary withdrawal of the drug.

CONCLUSION: Azathioprine is well tolerated and has therapeutic benefits lasting as long as 4 years. Adverse effects such as pancreatitis, hepatitis, cytopenias and gastrointestinal symptoms do occur but are controlled by drug withdrawal only.

Keywords: Ulcerative colitis; Azathioprine; Immuno-suppressive