Initiating Azathioprine for Crohn's Disease

Barrett G. Levesque, Edward V. Loftus

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Azathioprine (AZA) and 6-mercaptopurine are therapeutic options for patients with moderate to severe inflammatory Crohn's disease. AZA has both a complex metabolism and potential for adverse events that can be clinically challenging. AZA has been shown to maintain remission and reduce corticosteroid use in patients with Crohn's disease. There is heterogeneous thiopurine methyltransferase metabolism among patients, which has implications for clinical dosing and risk for adverse events. Routine thiopurine methyltransferase testing before the initiation of AZA will reduce early leukopenia and is mandatory to avoid potentially life-threatening myelotoxicity. Thiopurine metabolite assays may aid in the assessment of adherence and adverse events. Patients who do not respond to AZA therapy may benefit from the addition of biologic therapy or methotrexate.

Original languageEnglish (US)
Pages (from-to)460-465
Number of pages6
JournalClinical Gastroenterology and Hepatology
Issue number5
StatePublished - May 2012


  • 6-Mercaptopurine
  • 6-Methylmercaptopurine
  • 6-Thioguanine
  • Azathioprine
  • Crohn's Disease
  • Thiopurine Methyltransferase

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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