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Lack of effect of intravenous azathioprine on time to respond for steroid treated Crohn's disease
  1. M J CARTER,
  2. ALAN J LOBO
  1. Gastroenterology and Liver Unit
  2. Royal Hallamshire Hospital, Sheffield S10 2JF, UK
  3. m.j.carter@shef.ac.uk
  4. alan.lobo@csuh.nhs.uk

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6-Mercaptopurine and azathioprine are established treatments for Crohn's disease, both for maintenance1 and induction of remission.2 They are the agents of choice for steroid dependant disease. Their use in Crohn's disease is limited in two ways. Firstly, potentially serious dose dependant and idiosyncratic hypersensitivity side effects occur in a significant minority of patients treated. Secondly, the clinical effect has been said to have a prolonged time to onset with response rates only significantly increasing after 17 weeks of therapy,2 limiting usefulness in refractory active disease. Pharmacokinetic studies have suggested that the active metabolites of these drugs, the 6-thioguanine nucleotides (6TGN), have a long half life in red blood cells and slowly accumulate in tissues, requiring prolonged treatment to achieve steady state levels.3

Sandborn and colleagues have carefully addressed whether an intravenous loading dose of azathioprine would reduce the time to respond in patients with active Crohn's disease treated with steroids. …

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