title: Azathioprine for refractory ulcerative proctitis: A retrospective multicenter study.
abstract: BACKGROUND
  Efficacy of azathioprine (AZA) in refractory ulcerative proctitis (UP) is unknown.
  
  
  METHODS
  All patients treated with AZA for refractory UP in three referral centers between 2002 and 2012 were included. "Treatment success" in the long-term was defined as the absence of colectomy during follow-up, no need for anti-TNF during follow-up, no ongoing systemic steroids use, no adverse event leading to AZA withdrawal, and clinically quiescent disease at last follow-up.
  
  
  RESULTS
  Of the 1279 adult patients with ulcerative colitis, 25 patients were treated with AZA for refractory UP (median disease duration 4.9 years). Of these, 4 had no short-term clinical assessment. Of the remaining 21, 4 were primary non responders to AZA, 7 discontinued AZA for adverse events and 10 showed clinical improvement. At the long-term assessment at last follow up after a median of 46 months, 5 patients had treatment success and were still on AZA treatment, the remaining 20 were treatment failures. Of these, 5 discontinued AZA for adverse events and 15 were treated with infliximab (clinical response in 11 patients, primary non-response in one patient, and 3 underwent colectomy).
  
  
  CONCLUSIONS
  AZA may be efficacious in maintaining clinical response in one-fifth of patients with refractory UP in a real-life setting.
authors.affiliation: Department of Hepato-Gastroenterology, University Hospital of Pontchaillou, Rennes, France.
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Mallet
authors.affiliation: Department of Hepato-Gastroenterology, University Hospital of Pontchaillou, Rennes, France; Inserm 991, University of Rennes 1, France; CIC1414, Université de Rennes 1, France. Electronic address: guillaume.bouguen@free.fr.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Bouguen
authors.affiliation: Department of Gastroenterology, Inserm U954, Nancy University Hospital, Lorraine University, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Conroy
authors.affiliation: Department of Hepato-Gastroenterology, University Hospital of Saint-Etienne, Saint-Etienne, France; Inserm U954 and Department of Hepato-Gastroenterology, Nancy, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Roblin
authors.affiliation: Department of Hepato-Gastroenterology, University Hospital of Pontchaillou, Rennes, France.
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Delobel
authors.affiliation: Department of Hepato-Gastroenterology, University Hospital of Pontchaillou, Rennes, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Bretagne
authors.affiliation: Department of Hepato-Gastroenterology, University Hospital of Pontchaillou, Rennes, France; Inserm 991, University of Rennes 1, France; CIC1414, Université de Rennes 1, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Siproudhis
authors.affiliation: Department of Gastroenterology, Inserm U954, Nancy University Hospital, Lorraine University, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Peyrin-Biroulet
mesh_terms: D000328:Adult; D000368:Aged; D001379:Azathioprine / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000069285:Infliximab / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011349:Proctitis / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D000069285:Infliximab; D001379:Azathioprine
keywords: Azathioprine; Proctitis; Ulcerative colitis