Green, C.J.; Mee, A.S.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA63
Academic Journal
Introduction: Azathioprine is widely used as a steroid sparing agent in the management of inflammatory bowel disease. However, patient intolerance, which occurs in 9.3% limit its use. Methods: We conducted an observational study assessing the success of the slow re-introduction of azathioprine in previously intolerant patients. Patients who had been unable to take full dose azathioprine (1.5-2.0mg/kg) due to side effects primarily flu like illness, myalgia, and headaches were re-commenced on azathioprine at sub therapeutic doses (10-25mg). Their dose was increased in a stepwise fashion, increasing by 25mg every two weeks until they reached full dose (100mg). Results: Azathioprine was successfully reintroduced, achieving therapeutic dose in six patients (approximately 40% of the population in whom it was tried). Three patients had ulcerative colitis and three had Crohns disease. The male to female ratio was 2:4. AIl had initially stopped azathioprine due to a severe flu like illness with headache and myalgia. All were successfully restarted using the above regime. All tolerated the drug and have remained on it for a minimum of seven months at the time of writing. All had TPMT (thiopurine methyl transferase) levels on treatment within the normal range. Discussion: Azathioprine is a useful drug in the treatment of chronic inflammatory bowel disease. However, there is a significant side effect profile leading to morbidity as stated above. We show good observational evidence that previously intolerant patients can achieve useful dosing of this drug using a step up approach. Our anecdotal experience suggests that approximately 40% of intolerant patients can be managed in this way and therefore, possibly avoid surgery.


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