Related Experiment Videos
Azathioprine in the treatment of children with inflammatory bowel disease
M Verhave1, H S Winter, R J Grand
1Division of Pediatric Gastroenterology, Floating Hospital, Boston, MA 02111.
Insights
Azathioprine effectively treats pediatric inflammatory bowel disease, including ulcerative colitis and Crohn disease. Its use is recommended for refractory cases due to potential long-term safety concerns.
Area of Science:
- Pediatric Gastroenterology
- Immunosuppressive Therapy
- Inflammatory Bowel Disease
Background:
- Inflammatory bowel disease (IBD) encompasses ulcerative colitis and Crohn disease, affecting children.
- Current treatments may have limitations or side effects, necessitating alternative therapies.
Purpose of the Study:
- To evaluate the efficacy and safety of azathioprine as an adjunctive treatment for pediatric IBD.
- To assess response rates and time to response in children with ulcerative colitis and Crohn disease.
Main Methods:
- A 6-year study involving 21 pediatric patients (ages 3-17) with IBD.
- Patients received azathioprine (2 mg/kg/day) as an adjunct to their existing treatment regimen.
- Disease duration and follow-up were a median of 2 years.
Main Results:
- Sixteen of 21 patients showed a positive response to azathioprine.
- Complete responses were observed in 6 patients with ulcerative colitis and 6 with Crohn disease.
- Partial responses occurred in 1 patient with ulcerative colitis and 3 with Crohn disease; minimal side effects were noted.
Conclusions:
- Azathioprine demonstrates efficacy as an adjunctive treatment for pediatric IBD.
- The drug facilitates corticosteroid dose reduction in responsive patients.
- Long-term safety requires further investigation, suggesting reserved use for refractory or corticosteroid-intolerant cases.
Abstract:
During a 6-year period, we treated 21 patients with azathioprine, 2 mg/kg/day, as an adjunct to their customary regimen. Nine patients had ulcerative colitis and 12 patients had Crohn disease; the patients' ages ranged from 3 to 17 years. The median duration of disease before the start of azathioprine therapy was 2 years, and median follow-up was 2 years. Sixteen patients seemed to respond to azathioprine therapy: six patients in each disease group had complete responses and four patients (one with ulcerative colitis and three with Crohn disease) had partial responses. Two patients with ulcerative colitis and three patients with Crohn disease did not respond. The median time until patients responded was less than 3 months for patients with ulcerative colitis and 4 months for those with Crohn disease. Reduction of corticosteroid dose was possible for all patients who responded to azathioprine therapy. Only minimal side effects were attributable to the drug. We conclude that azathioprine is an effective adjunctive agent for the treatment of inflammatory bowel disease in childhood, but because questions remain regarding its long-term safety, its use should be reserved for children with refractory disease or severe and unacceptable side effects of corticosteroids.