Azathioprine is an efficient maintenance treatment of IBD, able to maintain a complete clinical and anatomical
remission in about one third of patients. However there are concerns regarding its long term tolerance, particularly myelosuppression
and malignancy. Azathioprine is not required in about one third of Crohn's Disease patients and more than
half of Ulcerative Colitis patients who will experience a mild disease course. In patients with more severe disease, although
anti-TNF agents are more powerful and act more rapidly, there is a subset of patients with moderate-to-severe IBD
without important anatomical damage who may achieve a prolonged steroid-free clinical and anatomical remission on
azathioprine monotherapy. It is thus advised to initiate azathioprine monotherapy in these intermediate cases, and to continue
azathioprine if anatomical remission is achieved.
Keywords: Anti-TNF agents, azathioprine, Crohn's disease, mercaptopurine, ulcerative coilitis.
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