Title: Audit of longterm azathioprine use in inflammatory bowel disease
Abstract: Objective: To review the long term use of azathioprine in patients with inflammatory bowel disease.Design: Retrospective review of patients' case notes, laboratory records and GP records.Subjects:51 patients with inflammatory bowel disease treated with azathioprine, and who were advised to have regular haematological checks at their GP's surgery, as per Departmental guidelines.Results:Patients with Crohn's disease: 21 04 female, 7 male.)Patients with Ulcerative Colitis: 28 03 female, 15 male.)Lymphocytic colitis: 1. Indeterminate colitis: I Age at diagnosis IBD: range 13-74 years.Mean: 38 years.Age at introduction of azathioprine: range 14-77 years.Mean 44 years.Duration on azathioprine: range < 1-113 months.Mean 32 months.8 patients stopped azathioprine due to side effects.5 patients underwent surgery whilst on azathioprine, 3 of whom had curative surgery.12 patients, well on maintenance azathioprine, had therapy withdrawn.8 of them, (67%), have relapsed at a mean time off azathioprine of 14 months.4 patients remain well off azathioprine therapy.Ofthe original 51 patients, 33 remain well on azathioprine + /-steroids.24 of these 33 are on azathioprine alone, and the majority of the rest on low dose maintenance steroids.Our full blood count monitoring was not as efficient as we had expected.Conciusions:Long term use of azathioprine in patients with inflammatory bowel disease is effective.67 % of patients who stopped azathioprine had a relapse of their disease.Current guidelines suggest that patients on azathioprine should have regular haematological monitoring, and we would agree with this.Our patients were not being monitored as regularly as we had expected from our protocol.More