Abstract
Objective
To pool the data of studies and to evaluate the efficacy and safety of low-dose azathioprine (AZA) for treating patients with chronic active ulcerative colitis.
Methods
Research subjects were patients with chronic active UC, including steroid-dependent colitis, steroid-refractory colitis patients or patients who couldn't achieve remission after full-dose 5-ASA treatment. The treatment of chronic active UC patients was low-dose AZA (≤1.5 mg/kg/d). After a systemic review of articles published in English and Chinese, six studies with 211 patients were eligible for the meta-analysis and systemic review. Data extracted from each study, including clinical efficacy (response rate, adverse drug reaction rate, steroid withdrawal rate and relapse rate), endoscopic improvement and publication bias, was analyzed and synthesized into overall rates and odds ratios using Stata 12.0.
Results
The overall response rates after 6-month and 12-month treatment were 78.0% (95%-CI 71.0%, 85.0%) and 88.0% (95%-CI 80.0%, 96.0%) respectively. The overall adverse drug reaction rate was 25.0% (95%-CI 19.0%, 32.0%). The endoscopic response rates were around 85.0%. The endoscopic remission rates and mucosal healing rates after 6-month and 12-month treatment were above 60.0% and 70.0% respectively. The steroid withdrawal rate and relapse rate were in moderate to high heterogeneity. Egger's test indicated that no publication bias existed for studies regarding 6-months response rate and ADR rate while it existed in studies regarding 12-months response rate.
Conclusions
Low-dose AZA is effective and safe in the treatment of chronic active ulcerative colitis patients. However, larger and randomized studies are needed to draw definitive conclusions.
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