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.
