A Systematic Review of the Clinical Effectiveness of Azathioprine in Patients with Ulcerative Colitis

Abstract

To clarify the eŠectiveness and safety of azathioprine (AZA) and 6-mercaptopurine (6MP) in the induction and maintenance of remission in ulcerative colitis (UC) by using a systematic review of published studies. References from published studies and reviews were also obtained. Randomized, placebo-controlled trials of oral AZA or 6MP therapy in adult patients with active or quiescent UC were included. Ratios for the induction and maintenance of remission, the steroid-sparing eŠect, and the incidence of adverse drug reactions (ADRs) were compared and evaluated between the two study arms and expressed by the odds ratio (OR) speciˆc for the individual studies and the meta-analytic summary for the OR. We couldˆnd no randomized controlled trial for 6MP therapy. However, four clinical trials for AZA therapy were included in this meta-analysis. For the induction of remission, the pooled OR of the response to AZA therapy compared with placebo in active UC was 1.45 (95％ Conˆdence Interval (CI): 0.68 to 3.08). For the maintenance of remission, the pooled OR for AZA therapy was 2.26 (95％ CI: 1.27 to 4.01). The number needed to treat (NNT) to prevent one recurrence was 6 patients. The pooled OR for AZA therapy's ADRs compared with placebo was 2.11 (95％ CI: 0.92 to 4.84). From the viewpoint of eŠective-ness and safety, this meta-analysis suggests that AZA might be useful in the maintenance of remission in UC patients.

Drug Monitoring in Inflammatory Bowel Disease: Helpful or Dispensable?

“…Azathioprine (AZA) and 6-mercaptopurine (6-MP) are a well-established, effective maintenance therapy for moderate and severe Crohn's disease (CD) [2] and for ulcerative colitis (UC) [3] . The use of AZA in CD has constantly increased since its first application in 1969 [4] to a cumulative 5-year probability of more than 50% [5] .…”

Genotipo y fenotipo de la enzima tiopurina metiltransferasa en población chilena

“…L os tiopurínicos, azatioprina (AZA) y 6-mercaptopurina (6-MP), son fármacos efectivos y ampliamente utilizados en diversas patologías complejas que presentan una prevalencia creciente como son las enfermedades infl amatorias intestinales (EII), hepatitis autoinmune, trasplante de riñón o hígado, lupus eritematoso sistémico, esclerosis múltiple o leucemia linfática aguda entre otras [1][2][3][4][5][6][7][8][9] . Sin embargo, existe una variabilidad individual en la efectividad y pueden producir importantes efectos adversos [1][2][3]10 .…”

“…Sin embargo, existe una variabilidad individual en la efectividad y pueden producir importantes efectos adversos [1][2][3]10 . Esto se debe principalmente a la dosis utilizada y a una susceptibilidad individual [1][2][3]10 .…”

“…Sin embargo, existe una variabilidad individual en la efectividad y pueden producir importantes efectos adversos [1][2][3]10 . Esto se debe principalmente a la dosis utilizada y a una susceptibilidad individual [1][2][3]10 . En las dosis utilizadas en pacientes con EII (2,0-3,0 mg/kg/día), los efectos adversos se observan en 10 a 20% de los pacientes [1][2][3]10 , los que incluyen mielotoxicidad, molestias gastrointestinales, toxicidad hepática o pancreatitis.…”

“…Esto se debe principalmente a la dosis utilizada y a una susceptibilidad individual [1][2][3]10 . En las dosis utilizadas en pacientes con EII (2,0-3,0 mg/kg/día), los efectos adversos se observan en 10 a 20% de los pacientes [1][2][3]10 , los que incluyen mielotoxicidad, molestias gastrointestinales, toxicidad hepática o pancreatitis. Entre estas, la mielotoxicidad es la más importante, la que puede llevar a una leucopenia potencialmente mortal 9,10 .…”