A 41 year old male patient presented with recurrent episodes of bloody diarrhea & mucus for 5 years. Despite regular treatment with adequate doses of sulfasalazine, he has had several exacerbations of his disease and required several weeks of steroids for the control for flares. What should be the next line of treatment for him?

Answer is B (Azathioprine) Maintenance therapy with sullasahrzine was not able to maintain the patient in remission and he required coicosteroid for the control of his exacerabations. Patient is now in remission and requines a drug which can maintain him in remission. Azathioprine reduces requirement of steroids in patients and maintains remission and this is thus the drug of choice here. This is a case of ulcerative colitis as suggested by the recurrent episodes of bloody diarrhoea. Azathioprine & Mercaptopurine :Promising drugs as maintenance therapy. Azathioprine and 6 mercupto- purine are effective in long term management of ulcerative colitis. They reduce the requirement of steroids in patient us well as maintain the patient in remission Cyclosporine: It is not effective in maintenance remission without 6 MP/ Azathioprine' - Harrison It's greatest value is in t/t of acute severe ulcerative colitis that does not appear to be responding adequately to glucocoicoid. However it does not reduce the rate of relapse and is not effective as maintenance therapy. Methotrexate: Methotrexate is useful in steroid dependent patient of Crohn's disease but its role in U.C. has not been mentioned. Cyclophosphamide has no role in the management of either Crohn's disease or ulcerative colitis.