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Treatment efficacy and safety of low‐dose azathioprine in chronic active ulcerative colitis patients: A meta‐analysis and systemic review
Author(s) -
Luan Zi Jian,
Li Yue,
Zhao Xin Yu,
Wang Li,
Sun Ying Hao,
Wang Shi Yao,
Qian Jia Ming
Publication year - 2016
Publication title -
journal of digestive diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 51
eISSN - 1751-2980
pISSN - 1751-2972
DOI - 10.1111/1751-2980.12386
Subject(s) - medicine , azathioprine , cochrane library , ulcerative colitis , meta analysis , adverse effect , publication bias , gastroenterology , randomized controlled trial , confidence interval , disease
Objective To evaluate the efficacy and safety of low‐dose azathioprine (AZA) in treating patients with chronic active ulcerative colitis (UC). Methods A literature search of Medline, Embase, the Cochrane Library, Web of Science, Wanfang Database, CNKI, SinoMed, VIP Chinese Science and the Technology Journals Database was conducted to identify eligible studies that evaluated the efficacy and safety of low‐dose azathioprine (AZA) in treating patients with chronic active UC published up to 15 July 2015. Data were extracted from the studies, including clinical efficacy (response rate, adverse drug reaction [ADR] rate, steroid withdrawal rate and relapse rate) and endoscopic improvement (endoscopic remission rate and mucosal healing rate). Results Six studies with 211 patients were eligible for the analysis. The overall response rates after 6 and 12 months of treatment were 78.0% (95% confidence interval [CI] 71.0–85.0%) and 88.0% (95% CI 80.0–96.0%), respectively. The overall ADR rate was 25.0% (95% CI 18.0–31.0%). Endoscopic response rate was around 85.0%, while the endoscopic remission rates and mucosal healing rates after 6 and 12 months of 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 there was no publication bias for studies regarding the 6‐month response rate and ADR rate. Conclusions Low‐dose AZA is effective and safe in the treatment of chronic active UC patients. However, randomized controlled trials with large sample sizes are needed to draw definitive conclusions.