Immunosuppressant drugs ulcerative colitis

Sands BE. Immunosuppressive drugs in ulcerative colitis twisting facts to suit theories Gut. 2006 55 437-441. 

The main drugs used in the treatment of ulcerative colitis and Crohn s disease are the aminosalicylates and corticosteroids. Their mode of action is obscure. Other immunosuppressives also have a role and recent studies into the mechanisms of inflammation are leading to the introduction of novel therapies to inhibit the inflammatory process. 

Ulcerative Colitis. The use of immunosuppressive drugs (6-mercapto-purine, busulfan, 6-thioguanosine, azathioprei ) in experimental therapy of ulcerative colitis has been reported. -106 Results have been encouraging in the small group of patients tested but potentially serious side effects were observed due to the high doses that were required. Disappointing features are the failure to achieve a cvire and the severity of relapse on suspension of treatment. 

Azathioprine is indicated in renal homotransplantation (five-year patient survival rate of 35%) in rheumatoid arthritis (for patients with severe, active, and erosive disease not responding to conventional therapies) and in chronic ulcerative colitis, myasthenia gravis, and Behcet s syndrome (adverse effects may offset its limited value). As with other cytotoxic drugs, azathioprine can affect rapidly growing cells, resulting in leukopenia, thrombocytopenia, and gastrointestinal toxicity. In addition, hepatotoxicity (cholestasis) has been reported. Many of the general problems of immunosuppression, such as increased risk of infections, can also occur. 

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