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205 SYSTEMATIC REVIEW LOOKING AT THE EFFECTIVENESS OF AZATHIOPRINE OR 6-MERCAPTOPURINE FOR THE MAINTENANCE OF CLINICAL REMISSION IN ULCERATIVE COLITIS Y Leung, R Panaccione, J Jones INTRODUCTION: Azathioprine (AZA) and 6-mercaptopurine (6-MP) are commonly used in inflammatory bowel disease as steroid sparing agents and to maintain disease remission. Although the use of these agents in Crohn's disease is well established, its role in the management of ulcerative colitis (UC) is less clear.
University of Calgary, Calgary, Alberta
AIM: A systematic review of randomized controlled trials was done to look at the effectiveness of AZA or 6-MP for the maintenance of clinical remission in UC.
METHODS: The databases Medline (1966-June 2006), EMBASE (1980-2006 Week 29), Cochrane Database of Systematic Reviews/ACP Journal Club/Database of Abstracts of Reviews of Effects and Cochrane Central Register of Controlled Trials (2nd Quarter 2006) were searched using the search terms 'azathioprine' and '6-mercaptopurine' which were combined using the Boolean operator OR. The search term 'ulcerative colitis' was combined with the original search strategy using the Boolean operation AND. A preliminary review of 43 abstracts was conducted to determine whether the trial met inclusion criteria. Bibliographies were reviewed for retrieved articles to identify any additional relevant articles. Inclusion of studies was agreed on by mutual consensus between reviewers and the reasons for exclusion were identified. Trials were analyzed for methodological quality using Chalmer's criteria.
RESULTS: Eight randomized controlled trials were selected for evaluation. All trials enrolled relatively small numbers of patients (maximum enrolled 80). Heterogeneity of study populations, interventions and outcome measures made direct comparison of estimates of effect difficult. Overall, the strength of the evidence in support of the use of AZA and 6-MP for maintenance of clinical remission in UC is weak.
CONCLUSIONS: At present the majority of the evidence for the use of AZA or 6-MP in maintaining remission in UC is from retrospective cohort studies rather than from large, multicenter, randomized clinical trials. A properly designed and adequately powered RCT is needed to establish the efficacy of these agents in the management of UC.