title: Long term results of use of azathioprine in patients with ulcerative colitis in India.
abstract: OBJECTIVE
  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 naive patients with severe disease; and (3) combination therapy (AZA + sulfasalazine or 5-aminosalicylates) for naive 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of gastroenterology, Dayanand Medical College and Hospital, Ludhiana 141001, India. ajitsood10@sify.com
authors.forename: Ajit
authors.initials: A
authors.lastname: Sood
authors.forename: Vandana
authors.initials: V
authors.lastname: Midha
authors.forename: Neena
authors.initials: N
authors.lastname: Sood
authors.forename: Manu
authors.initials: M
authors.lastname: Bansal
mesh_terms: D001379:Azathioprine / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007194:India; D012189:Retrospective Studies; D012459:Salicylates / Q000627:therapeutic use; D012460:Sulfasalazine / Q000627:therapeutic use
chemical_list: D005765:Gastrointestinal Agents; D007166:Immunosuppressive Agents; D012459:Salicylates; D012460:Sulfasalazine; D001379:Azathioprine