Retrospective case series analysis of patients with inflammatory bowel disease on azathioprine - A district general hospital experience

Objectives: The aim of this study was to look at our practice of using azat hioprine and to compare our results with those in published trials both fro m the point of view of response and also the side-effect profile. Design: A retrospective case series analysis was done on patients with inflammatory bowel disease (IBD)who were on azathioprine at Leicester General Hospital. Methods: 111 patients (47 males, 64 females, mean age 35.3 years) were incl uded from gastroenterology outpatients records between November 1997 and Au gust 1998. Clinical and demographic details were collected. Response in Cro hn's disease was determined using the Harvey-Bradshaw index. In case of ulc erative colitis the following parameters were used: stool frequency; rectal bleeding, weight gain, and general well-being. Logistic regression was per formed to look at the influence of age, sex and diagnosis in relation to th e response/relapse rate. Results: The average duration of treatment with az athioprine was 28.6 months. The starting dose of 1.53 mg/kg was similar to the maintenance dose (1.51 mg/kg). 58 patients had Crohn's disease and 53 p atients were diagnosed with ulcerative colitis. 85 patients were steroid-de pendent, 9 steroid-resistant, and 17 patients were started on azathioprine on the basis of extensive disease either seen at the time of endoscopy or r adiologically. Improvement in clinical features at 3, 6 and 12 months was 6 9.5, 77 and 84.1%, respectively. 74% patients showed an improvement in rela pse rates during the first year on azathioprine compared to 1 year prior to treatment. 68% patients who had shown improvement at 1 year were no longer taking steroids (p = 0.002). Logistic regression did not show any statisti cally significant influence of age, sex or diagnosis on response. 4.5% pati ents had leukopenia requiring dose reductions. Severe leukopenia (leukocyte count <2.5 x 10(9)/1) occurred in 3.6% patients. Conclusions: Response rat es in our IBD patients on azathioprine are comparable with those of the pub lished data despite using a relatively smaller dose. Copyright (C) 2000 S. Karger AG, Basel.