Objectives: The aim of this study was to look at our practice of using azathioprine and to compare our results with those in published trials both from the point of view of response and also the side-effect profile. Design: A retrospective case series analysis was done on patients with inflammatory bowel disease (IBD) who were on azathioprine at Leicester General Hospital. Methods: 111 patients (47 males, 64 females, mean age 35.3 years) were included from gastroenterology outpatients records between November 1997 and August 1998. Clinical and demographic details were collected.Response in Crohn’s disease was determined using the Harvey-Bradshaw index. In case of ulcerative colitis the following parameters were used: stool frequency; rectal bleeding, weight gain, and general well-being. Logistic regression was performed to look at the influence of age, sex and diagnosis in relation to the response/relapse rate. Results: The average duration of treatment with azathioprine was 28.6 months. The starting dose of 1.53 mg/kg was similar to the maintenance dose (1.51 mg/kg). 58 patients had Crohn’s disease and 53 patients were diagnosed with ulcerative colitis. 85 patients were steroid-dependent, 9 steroid-resistant, and 17 patients were started on azathioprine on the basis of extensive disease either seen at the time of endoscopy or radiologically. Improvement in clinical features at 3, 6 and 12 months was 69.5, 77 and 84.1%, respectively. 74% patients showed an improvement in relapse rates during the first year on azathioprine compared to 1 year prior to treatment. 68% patients who had shown improvement at 1 year were no longer taking steroids (p = 0.002). Logistic regression did not show any statistically significant influence of age, sex or diagnosis on response. 4.5% patients had leukopenia requiring dose reductions. Severe leukopenia (leukocyte count <2.5 × 109/l) occurred in 3.6% patients. Conclusions: Response rates in our IBD patients on azathioprine are comparable with those of the published data despite using a relatively smaller dose.

1.
Murray JE, Merril JP, Harrison JH, Wilson RE, Dammin GJ: Prolonged survival of human kidney homografts by immunosuppressive drug therapy. N Engl J Med 1963;268:1315&ndash;1323.
2.
Bean RHD: The treatment of chronic ulcerative colitis with 6-mercaptopurine. Med J Aust 1962;2:592&ndash;593.
3.
Kirk AP, Lennard-Jones JE: Controlled trial of azathioprine in chronic ulcerative colitis. BMJ 1982;284:1291&ndash;1292.
4.
Rosenberg JL, Wall AJ, Levin B, Binder HJ, Kirsner JB: A controlled trial of azathioprine in the management of chronic ulcerative colitis. Gastroenterology 1975;69:96&ndash;99.
[PubMed]
5.
Lennard-Jones JE: Azathioprine and 6-mercaptopurine have a role in the treatment of Crohn&rsquo;s disease. Dig Dis Sci 1981;77:364&ndash;368.
6.
Brooke BN, Hoffman DC, Swarbrick ET: Azathioprine for Crohn&rsquo;s disease. Lancet. 1969;ii:612&ndash;614.
7.
O&rsquo;Brien JJ, Bayless TM, Bayless JA: Use of azathioprine and 6-mercaptopurine in the initial treatment of Crohn&rsquo;s disease. Gastroenterology 1991;101:39&ndash;46.
[PubMed]
8.
Connell WR, Kamm MA, Ritchie JK, Lennard-Jones JE: Bone marrow toxicity caused by azathioprine in inflammatory bowel disease . 27 years of experience. Gut 1993;34:1081&ndash;1085.
[PubMed]
9.
Harvey RF, Bradshaw JM: A simple index of Crohn&rsquo;s disease activity. Lancet 1980;i:514.
10.
Theodor E, Niv Y, Bat L: Imuran in the treatment of ulcerative colitis. Am J Gastroenterol 1981;76:262&ndash;266.
[PubMed]
11.
Present DH, Korelitz BI, Wisch N, Glass JL, Sachar DB, Pasternack BS: Treatment of Crohn&rsquo;s disease with 6-mercaptopurine. A long-term randomised double blind study. N Engl J Med 1980;302:981&ndash;987.
[PubMed]
12.
Candy S, Wright J, Gerber M, Adams G, Gerig M, Goodman R: A controlled double blind study of azathioprine the management of Crohn&rsquo;s disease. Gut 1995;37:674&ndash;678.
[PubMed]
13.
Pearson DC, May GR, Fick GH, Sutherland LR: Azathioprine and 6-mercaptopurine in Crohn&rsquo;s disease: A meta-analysis. Gastroenterology 1994;106:A1045.
14.
O&rsquo;Donoghue DP, Davison AM, Powell-Tuck, Bown RL, Lennard-Jones JE: Double blind withdrawal trial of azathioprine as maintenance treatment for Crohn&rsquo;s disease. Lancet 1978;ii:955&ndash;957.
15.
Present DH, Chapman ML, Rubin PH: Efficacy of 6-mercaptopurine in refractory ulcerative colitis. Gastroenterology 1988;94:A359.
16.
Lobo AJ, Foster PN, Burke DA, Johnston D, Axon ATR: The role of azathioprine in the management of ulcerative colitis. Dis Colon Rectum 1990;33:374&ndash;377.
[PubMed]
17.
Adler DJ, Korelitz BI: The therapeutic efficacy of 6-mercaptopurine in refractory ulcerative colitis. Am J Gastroenterol 1990;85:717&ndash;722.
[PubMed]
18.
Bianchi Porro G, Petrillo M, Ardizzone S, Desideri S: Azathioprine in the treatment of ulcerative colitis. J Clin Gastroenterol 1991;13:113&ndash;114.
[PubMed]
19.
Hawthorne AB, Logan RFA, Hawkey CJ, Foster PN, Axon AT, Swabrick ET, Scott BB: Randomised controlled trial of azathioprine withdrawl in ulcerative colitis. BMJ 1992;305:20&ndash;22.
[PubMed]
20.
Ardizzone S, Molteni F, Imbesi V, Bollani S, Porro GB: Azathioprine in steroid resistant and steroid dependant ulcerative colitis. J Clin Gastroenterol 1997;25:330&ndash;333.
[PubMed]
21.
Ewe K, Press AG, Singe CC, Stufler M, Ueberschacr B, Hommel G, Meyer zum Buschenfelde KH: Azathioprine combined with prednisolone or monotherapy with prednisolone in active Crohn&rsquo;s disease. Gastroenterology 1993;105:367&ndash;372.
[PubMed]
22.
Pearson DC, May GR, Fick GH, Sutherland LR: Azathioprine and 6-mercaptopurine in Crohn&rsquo;s disease. Ann Intern Med 1995;122:132&ndash;142.
23.
Summers RW, Switz DM, Sessions JT, Becktel JM, Best WR, Kern F, Singleton JW: National Co-operative Crohn&rsquo;s Disease study: Results of drug treatment. Gastroenterology 1979;77:847&ndash;869.
[PubMed]
24.
Korelitz BI, Adler DJ, Mendelsohn RA, Sacknoff A: A long-term experience with 6-mercaptopurine in the treatment of Crohn&rsquo;s disease. Am J Gastroenterol 1993;88:1198&ndash;1205.
[PubMed]
25.
Bouhnik Y, Lemann M, Mary JY, Scemama G, Tai R, Matuchansky C, Modigliani R, RambaudJC: Long-term follow-up of patients with Crohn&rsquo;s disease treated with azathioprine or 6-mercaptopurine. Lancet 1996;347:215&ndash;219.
[PubMed]
26.
Nyman M, Mansson I, Eriksson S: Long-term immunosuppressive treatment in Crohn&rsquo;s disease. Scand J Gastroenterol 1985;20:1197&ndash;1203.
[PubMed]
27.
Present DH, Meltzer SJ, Krumholz MP, Wolke A, Korelitz BI: 6-Mercaptopurine in the management of inflammatory bowel disease: Short- and long-term toxicity. Ann Intern Med 1989;111:641&ndash;649.
[PubMed]
28.
Connel WR, Kamm MA, Ritchie JK, Lennard-Jones JE: Bone marrow toxicity caused by azathioprine in inflammatory bowel disease: 27 years of experience. Gut 1993;34:1081&ndash;1085.
[PubMed]
29.
Goldstein F: Immunosuppressant treatment of inflammatory bowel disease. Pharmacological and clinical aspects. J Clin Gastroenterol 1987;9:654&ndash;658.
[PubMed]
30.
McLeod HL, Miller DR, Evans WE: Azathioprine-induced myelosuppression in thiopurine methyltransferase deficient heart transplant recipients (letter). Lancet 1993;341:1151.
31.
Yates CR, Krynetski EY, Loennechen T, Fessing MY, Tai HL, Pui CH, Relling MV, Evans WE: Molecular diagnosis of thiopurine S-methyltransferase deficiency: Genetic basis for azathioprine and mercaptopurine intolerance. Ann Intern Med 1997;126:608&ndash;614.
[PubMed]
32.
Kerstens PJ, Stolk JN, Hillbrands LB, van de Putte LB,De Abreau RA, Boerbooms AM: 5-Nucleotidase and azathioprine-related bone-marrow toxicity (letter). Lancet 1993;342:1245&ndash;1246.
33.
Kinlen LJ: Malignancy in autoimmune diseases. Autoimmunity 1992;78:44&ndash;49.
34.
Connell WR, Kamm MA, Dickson M, Balkwill AM, Ritchie JK, Lennard-Jones JE: Long-term neoplasia risk after azathioprine treatment in inflammatory bowel disease. Lancet 1994;343:1249&ndash;1252.
[PubMed]
35.
Tuchmann-Duplessis H, Mercier-Parot L: Production in rabbits of malformations of the extremities by azathioprine and 6-mercaptopurine (in French). C R Seances Soc Biol Fil 1966;166:501&ndash;506.
36.
Alstead EM, Ritchie JK, Lennard-Jones JE, Farthing MJG, Clark ML: Safety of azathioprine in pregnancy in inflammatory bowel disease. Gastroenterology 1990;99:443&ndash;446.
[PubMed]
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