Related Experiment Video
Updated: Jun 30, 2026
08:38
Quantification of the Immunosuppressant Tacrolimus on Dried Blood Spots Using LC-MS/MS
Published on: November 8, 2015
Are we giving azathioprine too much time?
Fernando Gomollón1, Santiago García López
1Hospital Clinico Universitario Lozano Blesa Zaragoza, Avenida San Juan Bosco 15, Zaragoza, Spain. fgomollon@gmail.com
World Journal of Gastroenterology
|September 24, 2008
Summary
For inflammatory bowel diseases, azathioprine is a safe and effective long-term maintenance drug. Continued use is recommended if the medication is well-tolerated and effective, as stopping it increases relapse risk.
Area of Science:
- Gastroenterology
- Immunosuppressive Therapy
- Pharmacology
Background:
- Azathioprine is a cornerstone in managing inflammatory bowel diseases (IBD).
- Long-term treatment strategies for chronic IBD require careful consideration of drug efficacy and safety.
- Optimal duration for azathioprine maintenance therapy in IBD remains a clinical question.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of azathioprine for maintenance treatment in inflammatory bowel diseases.
- To determine if azathioprine should be continued indefinitely in IBD patients experiencing therapeutic benefit and good tolerance.
- To assess the benefit-risk ratio of prolonged azathioprine use in IBD management.
Main Methods:
- Review of existing evidence on azathioprine's long-term efficacy in IBD.
- Analysis of data regarding the safety profile and potential side effects of prolonged azathioprine use.
- Consideration of meta-analyses and decision analyses concerning azathioprine's benefit-risk ratio.
Main Results:
- Azathioprine withdrawal significantly increases the risk of IBD relapse.
- The drug is generally well-tolerated for long-term use, with serious side effects being uncommon.
- While a slight increase in lymphoma risk exists, the overall long-term benefit/risk ratio favors continued azathioprine therapy when effective and tolerated.
Conclusions:
- Azathioprine should not be discontinued in IBD patients who are responding well and tolerating the medication.
- Indefinite maintenance therapy with azathioprine is recommended for effective IBD management.
- This recommendation applies to azathioprine as monotherapy and may not extend to combination therapy with biologics.
Related Concept Videos
01:29Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel Disease...
01:29Drugs for Treatment of Ulcerative Colitis in IBD
Ulcerative colitis is a chronic inflammatory condition primarily affecting the colon and rectum. The primary drugs used in the treatment of ulcerative colitis are aminosalicylates. They exhibit anti-inflammatory and immunosuppressive properties. They modulate inflammatory mediators and inhibit the activity of nuclear factor κB (NF-κB). Aminosalicylates also reduce inflammation by inhibiting prostaglandin and leukotriene production and decreasing neutrophil chemotaxis and superoxide generation.
01:29Inflammatory Bowel Disease IV: Pharmacological Management
Upon diagnosis, managing Inflammatory Bowel Disease (IBD) involves addressing several crucial aspects. The primary goals include resting the bowel, correcting malnutrition, and providing symptomatic relief. Resting the bowel may consist of medications to reduce inflammation and promote healing. Correcting malnutrition is essential, often requiring dietary adjustments and nutritional supplements. Symptomatic relief aims to ease pain, diarrhea, and other discomforts in IBD.
Pharmacologic...
Pharmacologic...
01:21Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2 (COX-2),...
01:24Drug Accumulation During Multiple Dosing: Intermittent IV Infusions
Intermittent intravenous (IV) infusion is a method of drug administration where medications are delivered over short infusion periods followed by intervals of no drug delivery. This approach helps to prevent sustained high drug concentrations in the bloodstream, reducing the risk of adverse effects associated with prolonged exposure. Unlike continuous infusion, steady-state concentrations may not be achieved during a single dosing cycle but can be reached through repeated...
01:27Pharmacogenetics of Phase II Enzymes: N-acetyltransferase, Thiopurine S-methyltransferase, UDP-glucuronosyltransferase
Phase II biotransformation reactions are essential for detoxifying and eliminating xenobiotics, including many pharmaceutical compounds. These reactions typically involve conjugation, the covalent attachment of polar endogenous groups such as glucuronic acid, sulfate, methyl, or acetyl moieties to functional groups introduced during Phase I metabolism. The resulting conjugates are more water-soluble, enabling efficient renal or biliary excretion.The major classes of Phase II enzymes include...