A Cochrane review [Abstract] 1 included 7 studies with a total of 302 subjects. Azathioprine was shown to be superior for the maintenance of remission as compared to placebo based on four trials (failure to maintain remission: RR 0.68, 95% CI 0.54 to 0.86; n = 232). Two trials that compared 6-mercaptopurine to mesalazine, or azathioprine to sulfasalazine showed significant heterogeneity. Adverse effects occurred in 11 of 127 patients receiving azathioprine compared to 3 of 130 recieving placebo (5 studies; RR 2.82, 95% CI 0.99 to 8.01). Adverse effects included acute pancreatitis (3 cases) and significant bone marrow suppression (5 cases).
Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison). The authors conclude that azathioprine may be an effective maintenance therapy for patients who have failed or cannot tolerate mesalazine or sulfasalazine and for patients who require repeated courses of steroids.
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