P345. The natural history of azathioprine therapy for steroid-dependent ulcerative colitis: a Korean study
S.K. Park1, S.K. Yang1, B.D. Ye1, K.J. Kim1, D.H. Yang1, K.W. Jung1, S.H. Park1, J.W. Kim1, J.S. Byeon1, S.J. Myung1, J.H. Kim1, 1Asan Medical Center, Gastroenterology, Seoul, South Korea
Azathioprine is widely used for the treatment of inflammatory bowel disease. In contrast to Crohn's disease, relatively few studies have addressed the therapeutic efficacy of azathioprine in patients with ulcerative colitis (UC). We aimed to evaluate efficacy of azathioprine in Korean patients with steroid-dependent UC.
We retrospectively reviewed 106 patients with steroid-dependent UC for whom azathioprine was started between October 1998 and May 2009. Six-month and 3-year outcomes after azathioprine therapy were evaluated.
Of the 106 patients, 73 (68.9%) were continued on azathioprine for more than six months (azathioprine group) and 33 (31.1%) discontinued azathioprine within six months due to intolerance (intolerance group, n = 20), colectomy (n = 6) or follow-up loss (n = 7). The most common reasons for intolerance were nausea and vomiting (n = 5), elevated liver enzymes (n = 5) and hair loss (n = 5). Six-month and 3-year outcomes for all 106 patients were remission in 70 (66%) and 67 (63.2%), corticosteroid dependence in 17 (16%) and 5 (4.7%), infliximab administration in 3 (2.8%) and 6 (5.6%), colectomy in 8 (7.5%) and 15 (14.2%), follow-up loss in 8 (7.5%) and 12 (11.3%), and death in 0 (0%) and 1 (0.9%), respectively. Six-month and 3-year outcomes for azathioprine group were remission in 57 (78%) and 60 (82.2%), corticosteroid dependence in 16 (22%) and 3 (4.1%), infliximab administration in 0 (0%) and 3 (4.1%), colectomy in 0 (0%) and 2 (2.7%), follow-up loss in 0 (0%) and 4 (5.4%), and death in 0 (0%) and 1 (1.3%), respectively. The azathioprine (n = 73) and the intolerance (n = 20) groups showed no significant difference in median age at diagnosis (37 years vs. 45 years, P = 0.17), proportion of male patients (61.6% vs. 40%, P = 0.12), median age at azathioprine therapy (40 years vs. 46 years, P = 0.27), median duration of UC before azathioprine (35.2 months vs. 17.6 months, P = 0.06), and median dose of azathioprine (1.06 mg/kg vs. 0.83 mg/kg, P = 0.39). The proportion of the patients remaining in remission was higher (88.2% vs. 36.8%, P < 0.001) in the azathioprine group compared with the intolerance group.
Azathioprine is an effective treatment for steroid-dependent UC. The efficacy of azathioprine is well sustained for 3 years.This study was supported by a grant of the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (A120176).