Christoph Schramm, MD; Peter Schirmacher, MD; Ilka Helmreich-Becker, MD; Guido Gerken, MD; Karl Heinz Meyer zum Büschenfelde, MD, PhD; Ansgar W. Lohse, MD
Requests for Reprints: Ansgar W. Lohse, MD, I. Department of Medicine, Johannes Gutenberg-University, Langenbeckstrasse 1, 55131 Mainz, Germany. For reprint orders in quantities exceeding 100, please contact the Reprints Coordinator; phone, 215-351-2657; e-mail, email@example.com.
Current Author Addresses: Dr. Schirmacher: Department of Pathology, University of Cologne, Josef Stelzmann Strasse 9, 50931 Köln, Germany.
Dr. Gerken: Department of Gastroenterology and Hepatology, University of Essen, Hufelandstrasse 55, 45147 Essen, Germany.
Drs. Schramm, Helmreich-Becker, Meyer zum Büschenfelde, and Lohse: Department of Internal Medicine, University of Mainz, Langenbeckstrasse 1, 55101 Mainz, Germany.
No established medical therapy alters the progressive course of primary sclerosing cholangitis.
To explore the potential usefulness of combined therapy with azathioprine, steroids and ursodeoxycholic acid (UDCA) in primary sclerosing cholangitis.
University hospital in Mainz, Germany.
15 patients with primary sclerosing cholangitis.
Azathioprine (1 to 1.5 mg/kg of body weight per day), prednisolone (1 mg/kg per day initially, tapering to 5 to 10 mg per day) and UDCA (500 to 750 mg per day).
Clinical and laboratory evaluation, liver biopsy, and endoscopic retrograde cholangiography (a >30% change in stenosis was considered significant).
After a median observation period of 41 months (range, 3 to 81 months), liver enzyme levels declined significantly in all patients. Six of 10 patients with follow-up liver biopsies showed histologic improvement. Significant radiographic deterioration was seen in only 1 of 10 patients who had endoscopic retrograde cholangiography. In 7 patients previously treated with UDCA alone, liver enzyme levels declined significantly only after immunosuppressive therapy was added. Adverse drug reactions led to the withdrawal of study medications in 2 patients.
Combined immunosuppressive therapy may alter the progression of primary sclerosing cholangitis. Our observations suggest a benefit from adding immunosuppressive drugs to UDCA therapy. A randomized trial is warranted.
Schramm C, Schirmacher P, Helmreich-Becker I, et al. Combined Therapy with Azathioprine, Prednisolone, and Ursodiol in Patients with Primary Sclerosing Cholangitis: A Case Series. Ann Intern Med. 1999;131:943–946. doi: 10.7326/0003-4819-131-12-199912210-00006
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Published: Ann Intern Med. 1999;131(12):943-946.
Biliary Disorders, Endocrine and Metabolism, Gastroenterology/Hepatology.
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