Exposing the weaknesses: a systematic review of azathioprine efficacy in ulcerative colitis.
BACKGROUND
Published trials evaluating the efficacy of 6-thioguanine anti-metabolites in the treatment of ulcerative colitis (UC) have yielded conflicting results. We performed a systematic review and meta-analysis to evaluate the clinical efficacy of 6-thioguanine anti-metabolites for the maintenance of clinical remission after standard induction with corticosteroids.


METHODS
A comprehensive search of online databases was conducted. Only randomized controlled trials with 6-thioguanine antimetabolites within a minimum duration of follow-up of 6 months were selected.


RESULTS
Five trials were included in the meta-analysis. The pooled relative risk estimate for "success of treatment" with azathioprine (AZA) compared to 5-aminosalicylic acid or placebo was 1.42 [95% confidence interval (CI): 0.93-2.17, p = 0.109]; when only trials of a higher quality were used, a pooled relative risk estimate of 2.05 (95% CI: 1.30-3.23, p = 0.002) was obtained.


CONCLUSIONS
Pooled results demonstrated a modest efficacy of AZA for the treatment of ulcerative colitis. However, the use of AZA for the management of UC is not based on high-quality evidence.
Leung
Yvette
Y
Division of Gastroenterology and Hepatology, University of Calgary Health Sciences Centre, G 087, 3330 Hospital Drive, NW, Calgary, AB, Canada.
Panaccione
Remo
R
Hemmelgarn
Brenda
B
Jones
Jennifer
J
D000963:Antimetabolites / Q000627:therapeutic use*; D001379:Azathioprine / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D015122:Mercaptopurine / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic
D000963:Antimetabolites; D015122:Mercaptopurine; D001379:Azathioprine