How Effective Is Azathioprine for Ulcerative Colitis?

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  • Written By: Clara Kedrek
  • Edited By: Jessica Seminara
  • Last Modified Date: 16 September 2019
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Administering azathioprine for ulcerative colitis can be a beneficial and effective treatment in certain cases. Azathioprine is effective in treating ulcerative colitis because the medication works by suppressing the overactive immune system that causes this disease. The main instance in which administering azathioprine for ulcerative colitis is effective is to allow doctors to decrease the dose of medications, called corticosteroids, which are commonly administered for this disease. Although the corticosteroids can prevent symptoms from occurring, their long-term use in high doses can have harmful side effects.

Using azathioprine for ulcerative colitis has been shown to be effective for a number of different patients suffering from this disease. It is effective because it alters the body’s immune system. Specifically, it inhibits the process of deoxyribonucleic acid (DNA) formation in the body, and selectively inhibits the activity of certain white blood cells that play a role in the body’s immune system. Since ulcerative colitis is an autoimmune disease, caused in part an overactive immune system that attacks native parts of the human body, the suppression of the body’s immune response leads to clinical regression of the disease.


Not all patients with ulcerative colitis should be treated with azathioprine. This medication has the most usefulness when it is given to help maintain remission of the disease. Patients with ulcerative colitis tend to have flares of disease activity, and experience acute worsening of symptoms including bloody diarrhea, abdominal pain, and fever during these disease flares. The flare itself is often treated with medications called corticosteroids in order to calm down the disease activity and allow for remission. Doses of corticosteroids are decreased as tolerated when the symptoms start to disappear.

If patients cannot be fully weaned off of corticosteroids after an acute flare, one option is to use azathioprine for ulcerative colitis. Adding on this medication often allows physicians to decrease the corticosteroid doses, which is beneficial because long-term use of the corticosteroids can have significant side effects. In some cases, adding azathioprine allows patients to be taken off of corticosteroid treatment entirely. Using azathioprine alone is considered by some specialists to be controversial, however, and they recommend continuing the use of both corticosteroids and azathioprine to prevent further disease flares.

One caveat for the use of azathioprine for ulcerative colitis is that prior to starting this medication in patients suffering from this inflammatory bowel disease, a number of different blood tests should be done. Either the activity of thiopurine methyltransferase (TPMT), or the genetic sequence that encodes TPMT must be evaluated prior to the initiation of therapy. Patients with low activity of TMPT should not be treated with azathioprine because they could experience more toxic affects from administration of this medication.


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