Nitrogen Mustard in the Treatment of Chronic Ulcerative Colitis and Regional Enteritis

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DRUGS originally developed for the treatment of malignant disease have been utilized in the therapy of certain nonneoplastic disorders—the various pathologic entities considered autoimmune diseases. Rheumatoid arthritis,1 disseminated lupus erythematosus,2 bronchial asthma,1,3 and nephrosis4,5 were treated with nitrogen mustard and other alkylating agents in the late 1940s and early 1950s, but then were almost entirely supplanted with corticosteroid preparations. In 1960, Damashek and Schwartz6 reported the use of antimetabolite drugs in treating auto-immune hemolytic anemia and disseminated lupus erythematosus. In 1963, Taylor7 reported the successful use of nitrogen mustard in the treatment of idiopathic autoimmune hemolytic anemia, but more recent reports have been concerned mostly with 6-mercaptopurine (6MP) or thioguanine (6-TG). These agents have been used to treat not only disseminated lupus erythematosus and autoimmune hemolytic anemia,6,8,9 but the nephrotic syndrome,8 lupoid hepatitis (plasma-cell hepatitis),8,10,11 scleroderma,11 atopic dermatitis,11 psoriasis,12 and hyperglobulinemic purpura.13 A single case of ulcerative colitis successfully treated with 6-mercaptopurine has also been reported by Bean.14 Bean15 at present has treated seven patients with antimetabolites (6-mercaptopurine, 6-thioguanine, and busulfan*); seven patients chronically ill with ulcerative colitis improved, as evaluated by serial biopsies of the rectum and serial barium-enema roentgenographic studies. Bowen, Irons, Rhodes, and Kirsner16 have utilized the immunosuppresive drug, azathioprine, to treat 10 patients with ulcerative colitis.

The frequent failure of chronic ulcerative colitis and regional enteritis and their complications to respond to medical treatment, the profound side effects of large doses of adrenocorticotropic hormone (ACTH) and corticosteroids necessary to maintain remission, and the postulated autoimmune . . .



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