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High-dose azathioprine in children with inflammatory bowel disease

D Fuentes1, F Torrente, S Keady

  • 1Centre for Paediatric Gastroenterology, Royal Free Hospital, London, UK.

Alimentary Pharmacology & Therapeutics
|March 27, 2003
PubMed

Insights

Azathioprine is safe and effective for children with inflammatory bowel disease (IBD) at 3 mg/kg. This study suggests it may improve growth in pediatric Crohn's disease patients, with low rates of surgery and adverse effects.

Area of Science:

  • Pediatric Gastroenterology
  • Immunosuppressive Therapy
  • Inflammatory Bowel Disease (IBD) Management

Background:

  • Azathioprine is a common maintenance therapy for pediatric moderate to severe IBD.
  • Limited data exists on higher azathioprine doses, growth impact, and surgical risks in children.

Purpose of the Study:

  • To evaluate the safety and efficacy of azathioprine maintenance therapy in pediatric IBD patients.
  • To assess the impact of azathioprine on growth and surgical morbidity in children with IBD.
  • To investigate the effects of higher azathioprine doses on growth in pediatric Crohn's disease.

Main Methods:

  • Retrospective cohort study of children diagnosed with IBD between 1996-2001.
  • Analyzed indications for azathioprine use, adverse effects, and discontinuation reasons.
  • Recorded height and weight, calculated standardized height Z-scores to assess growth.

Main Results:

  • 107 children received azathioprine at 3 mg/kg; 61% had Crohn's disease.
  • Low rates of azathioprine discontinuation (2/107) and surgery (16/107) were observed.
  • A trend towards improved growth was noted in pediatric Crohn's disease patients on high-dose azathioprine (P=0.08).

Conclusions:

  • Azathioprine at 3 mg/kg is a safe and well-tolerated maintenance therapy for pediatric IBD.
  • The study observed lower than previously reported rates of surgery and growth failure in this cohort.
  • High-dose azathioprine and nutritional support may optimize growth velocity in pediatric Crohn's disease.
Abstract

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