Azathioprine in ulcerative colitis: Why, when, how and how long to use it

Drug Development Research

Volumn 72, Issue 8, 2011, Pages 733-738

  Ribeiro, Tarsila Campanha Da Rocha ^a   Chebli, Liliana Andrade ^a   Gaburri, Pedro Duarte ^a   Chebli, Julio Maria Fonseca ^a  

^a FEDERAL UNIVERSITY OF JUIZ DE FORA   (Brazil)

Author keywords

azathioprine; immunosuppressant; inflammatory bowel disease; ulcerative colitis

Indexed keywords

AZATHIOPRINE; MERCAPTOPURINE; PLACEBO;

ALLERGY; ARTHRALGIA; BONE MARROW SUPPRESSION; DISEASE SEVERITY; DRUG DOSE INCREASE; DRUG EFFICACY; DRUG SAFETY; DRUG TOLERABILITY; ENTERITIS; FEVER; HUMAN; HYPERSENSITIVITY; INFECTION; LIVER TOXICITY; LOW DRUG DOSE; MALAISE; NAUSEA; PANCREATITIS; RASH; RECURRENT DISEASE; REMISSION; REVIEW; RISK ASSESSMENT; ULCERATIVE COLITIS;

EID: 83655203340     PISSN: 02724391     EISSN: 10982299     Source Type: Journal    
DOI: 10.1002/ddr.20481     Document Type: Review

References (47)

1. Andrews JM, Travis SP, Gibson PR, Gasche C,. 2009. Systematic review: does concurrent therapy with 5-ASA and immunomodulators in inflammatory bowel disease improve outcomes? Aliment Pharmacol Ther 29: 459.
2. Ardizzone S, Maconi G, Russo A, Imbesi V, Colombo E, Bianchi Porro G,. 2006. Randomised controlled trial of azathioprine and 5-aminosalicylic acid for treatment of steroid dependent ulcerative colitis. Gut 55: 47-53. (Pubitemid 41820634)
3. Askling J, Brandt L, Lapidus A, Karlén P, Björkholm M, Löfberg R, Ekbom A,. 2005. Risk of haematopoietic cancer in patients with inflammatory bowel disease. Gut 54: 617-622. (Pubitemid 40559243)
4. Baecklund E, Ekbom A, Sparén P, Feltelius N, Klareskog L,. 1998. Disease activity and risk of lymphoma in patients with rheumatoid arthritis: nested case-control study. BMJ 317: 180-181. (Pubitemid 28325543)
5. Baecklund E, Iliadou A, Askling J, et al. 2006. Association of chronic inflammation, not its treatment, with increased lymphoma risk in rheumatoid arthritis. Arthritis Rheum 54: 692-701.
6. Baecklund E, Iliadou A, Askling J, Ekbom A, Backlin C, Granath F, Catrina AI, Rosenquist R, Feltelius N, Sundström C, Klareskog L,. 2009. Lymphoproliferative disorders in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study. Lancet 374: 1617-1625.
7. Burger D, Travis S,. 2011. Conventional medical management of inflammatory bowel disease. Gastroenterology 140: 1827-1837.
8. Carter MJ, Lobo AJ, Travis SPL,. 2004. Guidelines for the management of inflammatory bowel disease in adults. Gut 53: S1-16.
9. Chebli LA,., Chaves LD, Pimentel FF, Guerra DM, Barros RM, Gaburri PD, Zanini A, Chebli JM,. 2010. Azathioprine maintains long-term steroid-free remission through 3 years in patients with steroid-dependent ulcerative colitis. Inflamm Bowel Dis 16: 613-619.
10. Coelho J, Beaugerie L, Colombel JF, Hebuterne X, Lerebours E, Lemann M, Baumer P, Cosnes J, Bourreille A, Gendre JP, et al. 2011. Pregnancy outcome in patients with inflammatory bowel disease treated with thiopurines: cohort from the CESAME study. Gut 60: 198-203.
11. Connell WR, Kamm MA, Ritchie JK, Lennard-Jones JE,. 1993. Bone marrow toxicity caused by azathioprine in inflammatory bowel disease: 27 years of experience. Gut 34: 1081-1085. (Pubitemid 23245359)
12. Cuffari C, Hunt S, Bayless T,. 2001. Utilisation of erythrocyte 6-thioguanine metabolite levels to optimise azathioprine therapy in patients with inflammatory bowel disease. Gut 48: 642.
13. Dubinsky MC,. 2004. Azathioprine, 6-mercaptopurine in inflammatory bowel disease: pharmacology, efficacy, and safety. Clin Gastroenterol Hepatol 2: 731-743. (Pubitemid 39200711)
14. Etchevers MJ, Aceituno M, Sans M,. 2008. Are we giving azathioprine too late? The case for early immunomodulation in inflammatory bowel disease. World J Gastroenterol 14: 5512-5518.
15. Faubion WA Jr, Loftus EV Jr, Harmsen WS, Zinsmeister AR, Sandborn WJ,. 2001. The natural history of corticosteroid therapy for inflammatory bowel disease: a population-based study. Gastroenterology 121: 255.
16. Francella A, Dyan A, Bodian C, Rubin P, Chapman M, Present DH,. 2003. The safety of 6-mercaptopurine for childbearing patients with inflammatory bowel disease: a retrospective cohort study. Gastroenterology 124: 9-17. (Pubitemid 36055333)
17. Fraser AG, Orchard TR, Jewell DP,. 2002. The efficacy of azathioprine for the treatment of inflammatory bowel disease: a 30 year review. Gut 50: 485-489. (Pubitemid 34638866)
18. Gisbert JP, Linares PM, McNicholl AG, Mate J, Gomollon F,. 2009. Meta-analysis: the efficacy of azathioprine and mercaptopurine in ulcerative colitis. Aliment Pharmacol Ther 30: 126-137.
19. Hawthorne AB, Logan RF, Hawkey CJ, Foster PN, Axon AT, Swarbrick ET, Scott BB, Lennard-Jones JE,. 1992. Randomised controlled trial of azathioprine withdrawal in ulcerative colitis. BMJ 305: 20-22.
20. Irving PM, Gearry RB, Sparrow MP, Gibson PR,. 2007. Appropriate use of corticosteroids in Crohn's disease. Aliment Pharmacol Ther 26: 313-329. (Pubitemid 47063143)
21. Jewell DP, Truelove SC,. 1974. Azathioprine in ulcerative colitis: final report on controlled therapeutic trial. BMJ 4: 627-630.
22. Kendiel A, Fraser AG, Korelitz BI, Bresinger C, Lewis JD,. 2005. Increased risk of lymphoma among inflammatory bowel disease patients treated with azathioprine and 6-mercaptopurine. Gut 54: 1121-1125. (Pubitemid 41025906)
23. Kornbluth A, Sachar DB,. 1997. Ulcerative colitis practice guidelines in adults. American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol 92: 204-211.
24. Leung Y, Panaccione R, Hemmelgarn B, Jones J,. 2008. Exposing the weaknesses: a systematic review of azathioprine efficacy in ulcerative colitis. Dig Dis Sci 53: 1455-1461. (Pubitemid 351624420)
25. Levesque B, Olkin I,. 2010. Azathioprine and ulcerative colitis: a "second-look" meta-analysis. Dig Dis Sci 55: 1186-1188.
26. Lewis JD, Bilker WB, Brensinger C, Deren JJ, Vaughn DJ, Strom BL,. 2001. Inflammatory bowel disease is not associated with an increased risk of lymphoma. Gastroenterology 121: 1080-1087. (Pubitemid 33022087)
27. Loftus Jr EV,. 2004. Clinical epidemiology of inflammatory bowel disease: incidence, prevalence, and environmental influences. Gastroenterology 126: 1504.
28. Masunaga Y, Ohno K, Ogawa R, Hashiguchi M, Echizen H, Ogata H,. 2007. Meta-analysis of risk of malignancy with immunosuppressive drugs in inflammatory bowel disease. Ann Pharmacother 41: 21-28. (Pubitemid 46145952)
29. Maté-Jiménez J, Hermida C, Cantero-Perona J, Moreno-Otero R,. 2000. 6-Mercaptopurine or methotrexate added to prednisone induces and maintains remission in steroid dependent inflammatory bowel disease. Eur J Gastroenterol Hepatol 12: 1227-1233.
30. Ng SC, Kamm M,. 2009. Therapeutic strategies for the management of ulcerative colitis. Inflamm Bowel Dis 6: 935-950.
31. Nielsen OH, Vainer B, Rask-Madsen J,. 2001. Review article: the treatment of inflammatory bowel disease with 6-mercaptopurine or azathioprine. Aliment Pharmacol Ther 15: 1699.
32. Ørding Olsen K, Juul S, Berndtsson I, Oresland T, Laurberg S,. 2002. Ulcerative colitis: female fecundity before diagnosis, during disease, and after surgery compared with a population sample. Gastroenterology 122: 15.
33. Panaccione R, Rutgeerts P, Sandborn WJ, Feagan B, Schreiber S, Ghosh S,. 2008. Treatment algorithms to maximize remission and minimize corticosteroid dependence in patients with inflammatory bowel disease. Aliment Pharmacol Ther 28: 674-688.
34. Paoluzi OA, Pica R, Marcheggiano A, Crispino P, Iacopini F, Iannoni C, Rivera M, Paoluzi P,. 2002. Azathioprine or methotrexate in the treatment of patients with steroid dependent or steroid-resistant ulcerative colitis: results of an open-label study on efficacy and tolerability in inducing and maintaining remission. Aliment Pharmacol Ther 16: 1751-1759.
35. Pearson DC, May GR, Fick GH, Sutherland LR,. 1995. Azathioprine and 6-mercaptopurine in Crohn disease. A meta-analysis. Ann Intern Med 123: 132.
36. Peyrin-Biroulet L, Lémann M,. 2011. Review article: remission rates achievable by current therapies for inflammatory bowel disease. Aliment Pharmacol Ther 33: 870-879.
37. Present DH, Meltzer SJ, Krumholz MP, Wolke A, Korelitz BI,. 1989. 6-Mercaptopurine in the management of inflammatory bowel disease: short- and long-term toxicity. Ann Intern Med 111: 641-649. (Pubitemid 19259182)
38. Rosenberg JL, Wall AJ, Levin B, Binder HJ, Kirsner JB,. 1975. A controlled trial of azathioprine in the management of chronic ulcerative colitis. Gastroenterology 69: 96-99.
39. Rosenberg JL, Wall AJ, Levin B, Binder HJ, Kirsner JB,. 1975. A controlled trial of azathioprine in Crohn's disease. Dig Dis Sci 20: 721-726.
40. Rutgeerts P, Vermeire S, Van Assche G,. 2009. Biological therapies for inflammatory bowel diseases. Gastroenterology 136: 1182-1197.
41. Sandborn W, Sutherland L, Pearson D, May G, Modigliani R, Prantera C,. 2000. Azathioprine or 6-mercaptopurine for inducing remission of Crohn's disease. Cochrane Database Syst Rev CD000545.
42. Schwartz M, Cohen R,. 2008 Optimizing conventional therapy for inflammatory bowel disease. Curr Gastroenterol Rep 10: 585-590.
43. Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR, Caprilli R, Colombel JF, Gasche C, Geboes K, et al. 2005. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol 19: 5-36.
44. Sood A, Midha V, Sood N,. 2000. Role of azathioprine in severe ulcerative colitis: one-year, placebo-controlled, randomized trial. Indian J Gastroenterol 19: 14-16. (Pubitemid 30048938)
45. Timmer A, McDonald JW, Macdonald JK,. 2007. Azathioprine and 6-mercaptopurine for maintenance of remission in ulcerative colitis. Cochrane Database Syst Rev CD000478.
46. Tremaine WJ,. 1997. Refractory IBD: medical management. Neth J Med 50: S12.
47. Weinshilboum RM, Otterness DM, Szumlanski CL,. 1999. Methylation pharmacogenetics: catechol O-methyltransferase, thiopurine methyltransferase, and histamine N-methyltransferase. Annu Rev Pharmacol Toxicol 39: 19.