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Azathioprine in paediatric inflammatory bowel disease: an Italian multicentre survey
A Barabino1, F Torrente, A Ventura
1Paediatric Gastroenterology, IRCCS G. Gaslini, Largo G. Gaslini 5, 16148 Genoa, Italy. abarab@tin.it
Insights
Azathioprine is effective for pediatric inflammatory bowel disease, enabling corticosteroid reduction in many. While generally safe, some children experienced side effects requiring treatment cessation.
Area of Science:
- Pediatric Gastroenterology
- Immunosuppressive Therapy
Background:
- Inflammatory bowel disease (IBD) presents significant challenges in pediatric populations.
- Azathioprine is an established immunosuppressive agent used in IBD management.
Purpose of the Study:
- To evaluate the efficacy and safety of azathioprine in children with inflammatory bowel disease.
- To assess the impact of azathioprine on corticosteroid use in this cohort.
Main Methods:
- Retrospective analysis of 123 Italian children treated with azathioprine for IBD.
- Assessment of treatment duration, reasons for discontinuation, side effects, and corticosteroid dose variations.
Main Results:
- Azathioprine therapy was associated with a statistically significant reduction in daily corticosteroid dose.
- 62% of patients achieved corticosteroid cessation or significant dose reduction.
- Side effects occurred in 39% of patients, but only 7% required azathioprine discontinuation.
Conclusions:
- Azathioprine demonstrated efficacy in 70% of pediatric IBD patients, with significant corticosteroid sparing.
- While generally well-tolerated, careful monitoring for side effects is warranted.
Aim:
To assess the efficacy and safety of azathioprine in a paediatric population with inflammatory bowel disease.
Patients And Methods:
One hundred and twenty-three Italian children treated with azathioprine were studied retrospectively. The treatment duration and causes of its discontinuation, side-effects and variation in corticosteroid dose were assessed.
Results:
The mean age at inflammatory bowel disease diagnosis was 9.8 +/- 3.6 years, and at the start of azathioprine therapy 11.8 +/- 4.3 years. The mean duration of treatment was 19 +/- 16 months. Fifty patients (41%) stopped treatment due to surgery (12%), prolonged remission (11%), non-response (7%), severe side-effects (7%) and poor compliance (3%). Of the 73 patients (59%) remaining on azathioprine, 11 had never been treated with corticosteroids, 27 were able to stop them and 35 were still on a very low daily dose (91% < 0.3 mg/kg). The difference in the daily corticosteroid dose between the beginning of azathioprine treatment (1 +/- 0.6 mg/kg) and the conclusion of the study (0.18 +/- 0.16 mg/kg) was statistically significant. Side-effects were recorded in 48 of the 123 patients (39%), but only eight required discontinuation of azathioprine.
Conclusions:
Azathioprine was efficacious in 70% of patients, but ineffective in 20% and induced severe toxicity in 7%. Corticosteroids were stopped or markedly reduced in 62% of patients, but they were never given in 9%.