Long term therapy of ulcerative colitis with 6-mercaptopurine: A personal series

Abstract

Fourteen patients with ulcerative colitis who were considered “failures of therapy with adrenal steroids and salicylazosulfapyridine” but who did not have an absolute indication for surgical intervention were treated with 6-mercaptopurine. The dose ranged from 50 to 150 mg daily and the mean period of treatment was 2 years. The current status is excellent or good in 11, fair in 2 and one patient has had elective surgery. In 8 patients the sigmoidoscopic appearance was recently normal, 6 have not required steroid therapy for many months and in the other 7, maintenance doses have been very small. Transient vomiting complicated therapy in 6 and leukopenia occurred 19 times in 10 patients. No serious complications occurred. The results suggest that responses to 6-mercaptopurine are not as dramatic as those observed with steroids but the former drug has a sustaining or supplementary role. It serves to decrease the frequency and severity of recurrences and eliminates or reduces the need for steroids. Complications are infrequent, not severe, and occur early in the course of therapy so that the drug may be used for long periods. The favorable results justify undertaking long-term, double-blind controlled studies of 6-mercaptopurine therapy in patients with ulcerative colitis when other forms of medical treatment have failed.