Long term results of use of azathioprine in patients with ulcerative colitis in India.
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.
Sood
Ajit
A
Department of gastroenterology, Dayanand Medical College and Hospital, Ludhiana 141001, India. ajitsood10@sify.com
Midha
Vandana
V
Sood
Neena
N
Bansal
Manu
M
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
D005765:Gastrointestinal Agents; D007166:Immunosuppressive Agents; D012459:Salicylates; D012460:Sulfasalazine; D001379:Azathioprine