Medical Management of Ulcerative Colitis: Conventional Therapy—Azathioprine

  • Barrett G. Levesque
  • Edward V. LoftusJr.Email author


Azathioprine and 6-mercaptopurine are effective therapies for maintaining steroid-free remission for many patients with ulcerative colitis. Genetic variation in the population leading to variable thiopurine metabolism warrants initial and ongoing laboratory monitoring throughout the course of treatment for dose-dependent toxicities such as leukopenia and hepatic biochemical abnormalities. Dose-independent toxicity, such as fever, pancreatitis, or flu-like illness, often occurs in the first few weeks of therapy, but some reactions (e.g., nausea) may be avoided by switching from azathioprine to 6-mercaptopurine. Infections are a primary risk of long-term therapy. There is an elevated relative risk of lymphoma during therapy; however, the absolute risk is relatively low. Future clinical trials may determine if the combination of azathioprine and biologic therapy is more effective in ulcerative colitis than either therapy alone.


Azathioprine Ulcerative colitis 


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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Division of GastroenterologyUniversity of California San DiegoLa JollaUSA
  2. 2.Division of Gastroenterology & HepatologyMayo ClinicRochesterUSA

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