My father has ulcerative colitis. Is Azathioprine safe at 54?

Question

Hello doctor,

I am asking about my father, who is 54 and has had ulcerative colitis for around six years now. Recently, he had a bad flare with frequent motions and blood again. The gastro doctor started Wysolone tablets for a few weeks. But we are concerned about a few things:

His symptoms have improved, but the doctor said steroids cannot be used long-term. Why is that so?
Are there serious side effects if taken repeatedly?
Also, they mentioned possibly starting Azathioprine if flares keep coming. Is that medicine safe for long-term immune suppression, or does it increase infection risk?

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Your father has ulcerative colitis, which is a chronic inflammatory disease of the colon that can have periods of remission and flare up with diarrhea, bleeding and urgency.

During moderate or severe flares, doctors often prescribe corticosteroids such as Prednisolone (Wysolone) because they quickly suppress inflammation and help control symptoms.

However, steroids are meant only for short-term control, not long-term maintenance. If used repeatedly or for many months, they can cause important side effects, such as:

Weight gain.
High blood sugar.
High blood pressure.
Bone thinning (osteoporosis).
Mood changes.
Increased infection risk.
Cataracts.
Adrenal suppression.

That’s why doctors try to cut down on the steroids once the symptoms have improved. If flares persist or symptoms recur during tapering of steroids, physicians may add steroid-sparing medications for long-term control.

A commonly used option is azathioprine, which moderately suppresses the immune system that causes the inflammation in ulcerative colitis. Steroids can be effective in maintaining remission and avoiding the need for additional courses of steroids.

Azathioprine is usually safe to use long term if used with caution. You will need blood tests from time to time to check your liver function and blood counts.

It does affect immune activity so there is some increased risk of infections but most patients tolerate it well with regular follow up.

Doctors weigh these risks against the greater harm of uncontrolled inflammation or repeated courses of steroids.

The aim of treatment for ulcerative colitis is to induce steroid-free remission, when the disease remains in remission without the need for repeated courses of steroids. With appropriate monitoring and individualised therapy many patients achieve stable disease control and enjoy a good quality of life.

I hope this helps.

Thank you.