title: Long-term efficacy and safety of azathioprine in ulcerative colitis.
abstract: OBJECTIVE
  Azathioprine (AZA) is an established treatment for ulcerative colitis (UC).However, controversy exists regarding its efficacy in inducing and maintaining clinical remission, and long-term data are lacking. We studied the effectiveness of AZA in a large cohort of UC patients treated in a single center.
  
  
  METHODS
  All UC patients treated with AZA were identified from a prospective electronic database. We assessed response to therapy at 4 months and sustained clinical benefit at the last point of follow-up. We also examined predictors of response and sustained clinical benefit, as well as outcomes in those treated with AZA for >5 years.
  
  
  RESULTS
  The study included 255 patients. At 4 months, 207 (81.2%) of 255 patients were still on AZA and 163 (63.9%) had responded to therapy. At the last point of follow-up 164 (64.3%) patients were still receiving AZA, of whom 154 (60.4%) achieved sustained clinical benefit. This effect was durable among 71 patients who received AZA for >5 years, with 61 (85.9%) considered to have achieved sustained clinical benefit. Twenty-six patients required admission to hospital for an exacerbation during AZA treatment, 20 patients ultimately required biologic therapy, and 21 underwent colectomy. Only two (2.8%) of 71 patients receiving AZA for >5 years needed to escalate to a biologic therapy, and only one (1.4%) required a colectomy.
  
  
  CONCLUSIONS
  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.
authors.forename: Ruchit
authors.initials: R
authors.lastname: Sood
authors.forename: Saqib
authors.initials: S
authors.lastname: Ansari
authors.forename: Tanya
authors.initials: T
authors.lastname: Clark
authors.forename: P John
authors.initials: PJ
authors.lastname: Hamlin
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Ford
mesh_terms: D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D011446:Prospective Studies; D012074:Remission Induction; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D001379:Azathioprine