Oral Ciclopsorin in Steroid Refractory, Acute, Severe Ulcerative Colitis
Pages 114-117
Sameer Gaggar and Nick P. Thompson
Dept. of Gastroenterology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS FT, Newcastle Upon Tyne, UK
http://dx.doi.org/10.12970/2308-6483.2014.02.03.6
Abstract: Objective: Ciclosporin (CsA) has been shown to be effective in treatment of steroid refractory severe ulcerative colitis. Most evidence concerns intravenous infusions, however oral microemulsion ciclosporin (Neoral®) is well absorbed, more convenient and potentially less toxic. We report our experience with oral CsA for treatment of steroid refractory severe ulcerative colitis.
Design: A retrospective audit using clinical and pathology databases to identify patientsfrom October 2001 to July 2012.
Setting: A single teaching hospital in northern England.
Patients: Consecutive patients with steroid refractory acute severe ulcerative colitis.
Intervention: Oral CsA.
Main Outcome Measures: Need for colectomy during admission and at one year and treatment complications.
Results: 30 patients received CsA on 31 occasions; 19 patients were males, median age was 42years. 19 patients had pancolitis and 11 patients had left sided colitis. 28 patients were treated as inpatients when CsA was started after a median of 5 days treatment with intravenous steroid. The mean CsA dose was 7.3 mg/kg. Mean length of treatment was 24 weeks. 26/31 (84%) had initial clinical response avoiding colectomy, however overall 15/31 (48%) had a colectomy within 1 year. 18 patients started on azathioprine or methotrexate after CsA response; 11 were thiopurine naïve with 8 (73%) remaining colectomy free. Onepatient developed pyrexia of unknown origin necessitating cessation of CsA.
Conclusions: Oral CsA is a safe and effective drug in steroid refractory acute ulcerative colitis with few significant side effects. Sustained response appears higher in thiopurine naïve patients treated with azathioprine.
Keywords: Ciclosporin, Ulcerative colitis, Cyclosporine.
