Combined immunosuppressive therapy with azathioprine and prednisone in patients with primary sclerosing cholangitis - a pilot study

Primary sclerosing cholangitis (PSC) is a progressive cholestatic liver disease of unknown cause. Immunologic abnormalities have been described. There is no medical therapy altering the progressive course of disease. The aim of the study was to evaluate the effect of combined immunosuppressive therapy plus ursodeoxycholic acid (UDCA) in PSC. 13 patients (7 male, 6 female; mean age 39 + 4 y) were treated with azathioprine (l1.5 mg/kg daily), prednisone (1 mg/kg and day initially, tapering to 5-10 mg/d maintenance therapy) and UDCA (750 mg/d) for a mean of 28 months (9 to 71 months). There was a rapid decline in liver enzymes that persisted throughout the observation period: alkaline phosphatase (1192 * 173 to 429 +98 U/l, pDuplex scanning of portal flow velocity showed an improvement from 13.1 to 16.3 cm/set. The promising results of this pilot study suggest the need to further evaluate combined immunosuppressive treatment with UDCA in patients with PSC.