AIM: To evaluate the role of azathioprine (AZA) in Indian patients with ulcerative colitis over longer duration of time. METHODS: One hundred f ifty six patients with ulcerative colitis who were treated with AZA from January 1995 to December 2003 were reviewed. The indications for its use were as follows: (1) steroid dependent and steroid refractory disease; (2) Azathioprine monotherapy for na?ve patients with severe disease; and (3) combination therapy (AZA + sulfasalazine or 5-aminosalicylates) for na?ve patients with severe disease. The data included patient and disease demographics, effi cacy and toxicity profi le of AZA. Patients with a minimum duration of 6 mo use of AZA were included in this report. RESULTS: Of a total of 156 patients treated with AZA, 45 were excluded from analysis for the following reasons- (follow up less than 6 mo, n = 9; poor follow up, n = 18; adverse affects, n = 18). In steroid refractory/dependent group the mean number of relapses prior to and post initiation of AZA therapy were 3.28 (± 0.81) and 0.94 (± 0.29) respectively. Discontinuation of steroids could be accomplished in 12 of the 15 steroid dependent patients. The proportion of patients with sustained remission of 1, 2, 3, 4 and 5 years duration were calculated. Eighteen patients experienced adverse effects necessitating withdrawal of AZA (pancreatitis, n = 7; hepatitis, n = 3; gastrointestinal intolerance, n = 2; alopecia, n = 2; and hematological, n = 4) while 13 patients needed dose reduction or temporary withdrawal of the drug. CONCLUSION: Azathioprine is well tolerated and hastherapeutic benefi ts lasting as long as 4 years. Adverse effects such as pancreatitis, hepatitis, cytopenias and gastrointestinal symptoms do occur but are controlled by drug withdrawal only. AIM: To evaluate the role of azathioprine (AZA) in Indian patients with ulcerative colitis for longer duration of time. METHODS: One hundred f ifty six patients with ulcerative colitis who were treated with AZA from January 1995 to December 2003 were reviewed. The indications (2) Azathioprine monotherapy for na? ve patients with severe disease; and (3) combination therapy (AZA + sulfasalazine or 5-aminosalicylates) for na? ve Patients with severe disease. The data included patient and disease demographics, effi cacy and toxicity profi le of AZA. Patients with a minimum duration of 6 mo use of AZA were included in this report. RESULTS: Of a total of 156 patients treated with AZA , 45 were excluded from analysis for the following reasons- (follow up less than 6 mo, n = 9; poor follow up, n = 18; adverse affects, n = 18). In steroid refractory / dependent group the mean number of relapses prior to and post init The proportion of patients with sustained remission of 1, 2, 3, 4 and 5 years of age were calculated. Eighteen patients experienced adverse effects necessitating withdrawal of AZA (pancreatitis, n = 7; hepatitis, n = 3; gastrointestinal intolerance, n = 2; and alopecia n = 2; needed dose reduction or temporary withdrawal of the drug. CONCLUSION: Azathioprine is well tolerated and hastherapeutic benefi ts lasting as long as 4 years. Adverse effects such as pancreatitis, hepatitis, cytopenias and gastrointestinal symptoms do occur but are controlled by drug withdrawal only.