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Intravenous azathioprine in severe ulcerative colitis: a pilot study
U Mahadevan1, W J Tremaine, T Johnson
1Division of Gastroenterology and Hepatology, University of California, San Francisco, USA.)
The American Journal of Gastroenterology
|January 11, 2001
Summary
Intravenous azathioprine offers a safe and effective option for severe ulcerative colitis, rapidly inducing remission and preventing colectomy. This approach may overcome the slow onset typically associated with oral azathioprine therapy.
Area of Science:
- Gastroenterology
- Clinical Pharmacology
Background:
- Ulcerative colitis (UC) is a chronic inflammatory bowel disease.
- Severe steroid-refractory UC poses significant treatment challenges.
- Azathioprine's slow onset limits its use in acute settings.
Purpose of the Study:
- To evaluate the safety and efficacy of an intravenous (i.v.) loading dose of azathioprine.
- To assess its clinical benefit in severe steroid-refractory ulcerative colitis.
Main Methods:
- Nine hospitalized patients with severe steroid-refractory UC were enrolled.
- Patients received varying i.v. azathioprine loading doses (20-40 mg/kg) over 3 days.
- Clinical remission, Inflammatory Bowel Disease Questionnaire scores, and 6-thioguanine levels were monitored.
Main Results:
- 56% of patients responded to i.v. azathioprine, avoiding colectomy.
- 33% achieved clinical remission within 4 weeks.
- Transient leukopenia and hepatotoxicity were observed in two and one patient, respectively.
Conclusions:
- Intravenous azathioprine is safe and clinically beneficial for inducing response in severe steroid-refractory UC.
- It may help avoid colectomy in this patient population.
- Further research is needed on oral dosing and metabolite monitoring for UC.