Related Experiment Video

Updated: May 29, 2026

Evaluating Therapeutic Interventions in the SHIP-deficient Mouse Model of Crohn Disease-like Ileitis and Fibrosis
09:44

Evaluating Therapeutic Interventions in the SHIP-deficient Mouse Model of Crohn Disease-like Ileitis and Fibrosis

Published on: October 14, 2025

Tolerance and efficacy of azathioprine in pediatric Crohn's disease

Laura Riello1, Cécile Talbotec, Hélène Garnier-Lengliné

  • 1Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paediatric Gastroenterology Unit, Paris, France.

Inflammatory Bowel Diseases
|September 13, 2011
PubMed

Insights

Azathioprine (AZA) maintains remission in pediatric Crohn's disease (CD) patients, though less effectively than previously thought. Most patients achieving remission at 12 months sustained it, with excellent overall tolerance observed.

Area of Science:

  • Pediatric Gastroenterology
  • Immunomodulatory Therapy
  • Inflammatory Bowel Disease Research

Background:

  • Thiopurines are first-line treatments for moderate to severe pediatric Crohn's disease (CD) to prevent relapse.
  • Early thiopurine introduction demonstrated high steroid-free remission rates (90%) for 18 months in a prior pediatric trial.
  • This study evaluates azathioprine (AZA) efficacy and tolerance for maintaining remission in pediatric CD.

Purpose of the Study:

  • To assess the efficacy of azathioprine (AZA) in maintaining steroid-free remission in pediatric Crohn's disease (CD) patients.
  • To evaluate the tolerance and safety profile of AZA in this pediatric cohort.
  • To compare real-world outcomes with previous trial data on thiopurine therapy for pediatric CD.

Main Methods:

  • Retrospective evaluation of 105 pediatric CD patients treated with AZA (1.4-4 mg/kg).
  • Efficacy assessed by Pediatric Crohn's Disease Activity Index (PCDAI) at 6, 12, 18, and 24 months; remission defined as PCDAI ≤10 without steroids.
  • Relapse criteria included need for anti-TNF medication, other immunomodulators, or surgery.

Main Results:

  • Steroid-free remission rates were 60.2% at 6 months, decreasing to 31.2% by 24 months.
  • AZA was discontinued in 10/93 patients within 4 weeks due to adverse reactions or low TPMT activity.
  • No neutropenia occurred in patients with normal TPMT; three infectious episodes required temporary AZA suspension.

Conclusions:

  • AZA demonstrates efficacy in maintaining remission for pediatric CD, albeit at lower rates than previously suggested.
  • Patients in steroid-free remission at 12 months generally maintained prolonged remission.
  • The overall tolerance of AZA in this pediatric cohort was excellent.
Abstract

More Related Videos

Quantification of the Immunosuppressant Tacrolimus on Dried Blood Spots Using LC-MS/MS08:38

Quantification of the Immunosuppressant Tacrolimus on Dried Blood Spots Using LC-MS/MS

Published on: November 8, 2015

Related Concept Videos

Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents01:29

Drugs 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...
Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids01:21

Drugs 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),...
Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF01:24

Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF

Tumor Necrosis Factor (TNF), a proinflammatory cytokine, contributes significantly to the inflammation seen in Crohn's disease. It exists as soluble TNF and membrane-bound TNF, with actions mediated through TNF receptors (TNFR). TNFR activation leads to the release of proinflammatory cytokines, T-cell activation, collagen production, and leukocyte migration, all contributing to inflammation in Crohn's disease. Anti-TNF monoclonal antibodies, namely infliximab (Remicade), adalimumab (Humira),...
Drugs for Treatment of Ulcerative Colitis in IBD01:29

Drugs 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. 
Pharmacokinetics in Pediatric Patients: Drug Metabolism01:24

Pharmacokinetics in Pediatric Patients: Drug Metabolism

In pediatric care, understanding the nuances of hepatic drug metabolism is crucial, as it significantly differs from that of adults. This divergence is primarily due to the developmental stage of drug-metabolizing enzymes, which affects how medications are processed in the body. In neonates, for instance, the activity of Phase I enzymes—critical for the initial breakdown of drugs—is markedly reduced, functioning at just 20–40% of the levels seen in adults. This reduction poses a challenge in...
Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...