Induction of remission by interferon-alpha in patients with chronic active ulcerative colitis.
OBJECTIVE
To ascertain whether treatment with interferon-alpha 2a (IFN-alpha 2a) can induce remission in patients with chronic active ulcerative colitis.


METHODS
Prospective, open-label study.


METHODS
The gastroenterology section of Ankara University School of Medicine, which is the regional referral centre for the city of Ankara.


METHODS
The study included 28 in-patients with established ulcerative colitis and lacking known pathogens. The diagnosis was confirmed using endoscopic, radiological and histological techniques. Patients enrolled in the study had previously shown resistance to 5-aminosalicylic acid and steroids.


METHODS
Disease activity was evaluated clinically and endoscopically. Laboratory parameters (erythrocyte sedimentation rate, haematocrit, and serum albumin levels) were used as indirect markers of inflammatory status. After a 10 day washout period, patients were treated with IFN-alpha 2a.


METHODS
IFN-alpha 2a therapy started with 3 MIU (one subcutaneous injection) and was increased to 6 MIU (one subcutaneous injection) and then 9 MIU three times a week (three subcutaneous injections every second day for 1 week) to habituate the patients and ensure early onset of action. The dose was then decreased to 6 MIU (three injections every second day for 1 week) and maintained at 3 MIU (three times a week) for 6-12 months.


RESULTS
Clinically, 71% per cent of the patients had severe and 29% moderate ulcerative colitis activity before the treatment. Five patients (18%) did not respond to IFN-alpha 2a therapy within the first 2 months; two of them underwent total colectomy and the remaining three (11%) achieved late remission after prolonged IFN-alpha 2a therapy. Twenty-three (82%) patients responded to therapy with a fast improvement (within 15 days) and were in complete clinical and endoscopic remission after 6 months of therapy. During the treatment period, four (14.2%) patients with pre-existing small haemorrhoids suffered from enlarged ulcerated and bleeding external haemorrhoids, and flu-like symptoms were a common side effect. No adverse effects serious enough to necessitate discontinuation of the therapy were observed. Twenty-six (93%) patients were observed for more than 2 years without being given therapy and remained in full clinical and endoscopic remission during this period.


CONCLUSIONS
In our opinion, IFN-alpha 2a is a well-tolerated, non-toxic, easily applicable and outstanding drug, which could become the treatment of choice for first-line therapy of chronic active ulcerative colitis, especially in patients who show resistance to other drugs.
Sümer
N
N
Gastroenterology Section, School of Medicine, Ankara University, Ibni Sina Hospital, Turkey.
Palabiyikoğlu
M
M
D000328:Adult; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D003106:Colon / Q000473:pathology; D003113:Colonoscopy; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use*; D008297:Male; D011446:Prospective Studies; D011994:Recombinant Proteins; D012074:Remission Induction; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins