American Board of Internal Medicine (ABIM) Certification Practice Exam

Which medication is commonly used for maintenance therapy in glucocorticoid-responsive ulcerative colitis?

1. Cyclosporine

2. Azathioprine or 6-MP

3. Infliximab

4. Prednisone

The correct answer is: Azathioprine or 6-MP

Azathioprine and 6-mercaptopurine (6-MP) are immunosuppressive medications that are often prescribed for long-term maintenance therapy in patients with glucocorticoid-responsive ulcerative colitis. The rationale behind their use is to help maintain remission and reduce the reliance on corticosteroids, which can have significant side effects when used long-term. These medications work by inhibiting purine synthesis, thereby suppressing the immune response that contributes to the inflammation seen in ulcerative colitis. By maintaining remission, they help prevent disease flares and improve overall patient quality of life. In contrast, medications like cyclosporine and infliximab are typically used in different contexts, such as severe acute exacerbations or refractory disease, rather than as maintenance therapy. Prednisone, while effective for inducing remission in acute flares, is not ideal for long-term use due to its side effects and risks associated with prolonged therapy.