Azathioprine and mercaptopurine in the management of patients with chronic, active microscopic colitis
Article first published online: 24 FEB 2013
© 2013 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 37, Issue 8, pages 795–798, April 2013
How to Cite
Aliment Pharmacol Ther 2013; 37: 795–798
- Issue published online: 18 MAR 2013
- Article first published online: 24 FEB 2013
- Manuscript Accepted: 3 FEB 2013
- Manuscript Revised: 31 JAN 2013
- Manuscript Revised: 30 JAN 2013
- Manuscript Received: 20 JAN 2013
Microscopic colitis (MC) is a common chronic diarrhoeal disease, and remission can be induced with budesonide. However, diarrhoea relapses frequently when budesonide is tapered and a few patients become budesonide intolerant.
To examine retrospectively the effect of azathioprine (AZA) and mercaptopurine (MP) in patients with chronic, active MC.
Data on all MC patients who received AZA or MP in the years 1997–2011 at three centres representing three countries were pooled for analysis. The indications for thiopurine therapy were frequent relapses after short-term treatment (N = 26), budesonide dependency on 6 mg (N = 15) and budesonide intolerance (N = 5). The response to thiopurine treatment was defined as clinical remission, intolerance or nonresponse.
Forty-six MC patients (32 CC and 14 LC), 32 female; median age 59 years (range: 36–83) with a median disease duration of 3 years (range: 0.5–18) were included. Thirteen patients (28%) achieved long-term clinical remission on AZA therapy. AZA failed in 31 patients (67%) due to intolerance and in 2 patients (4%) because of nonresponse. Thirteen of 31 AZA-intolerant patients were switched to MP and 6 patients (46%) obtained clinical remission. Thus, the overall response rate to thiopurines was 19/46 (41%). The main side effects were nausea/vomiting and abnormally elevated liver enzymes.
In this retrospective case series, the majority of chronic, active MC patients were intolerant to AZA leading to cessation of treatment. However, further studies are needed to explore the efficacy, acceptance, tolerance and safety of MP in patients with chronic, active MC refractory to budesonide.