Cyclosporin in the treatment of adults with refractory coeliac disease--an open pilot study.
OBJECTIVE
To evaluate the effect of cyclosporin treatment on clinical and histological parameters in adult patients with refractory coeliac disease.


METHODS
Thirteen patients were treated with oral cyclosporin for 2 months, aiming at serum levels of 100-200 ng/mL. Seven extended medication intake up to a maximum of 12 months. Before and after treatment, clinical parameters were monitored and small intestinal biopsies taken. Ten of 13 patients were typed for HLA-DQA1 and -DQB1 alleles.


RESULTS
Eight of 13 patients responded histologically to cyclosporin treatment. Normalization of villi was demonstrated in five patients, three after prolonged treatment. Eight patients reported a clinical response, of whom six had concomitant histological improvement. No serious side-effects of cyclosporin were noticed. Nine of 10 patients who were immunogenetically typed carried the coeliac disease associated serologic DQ2 markers, one carried neither DQ2 nor DQ8 markers.


CONCLUSIONS
In our study group of 13 adult refractory coeliac disease patients, cyclosporin in therapeutic doses induced a histological improvement in eight patients (61%), in five of whom (38%) normalization of villi was demonstrated. Thus, we believe that cyclosporin is a therapeutic option in refractory coeliac disease, although we could not confirm earlier reports of unconditional successful treatment.
Wahab
P J
PJ
Department of Gastroenterology & Hepatology, University Hospital Nijmegen. pwahab@rijnstate.nl
Crusius
J B
JB
Meijer
J W
JW
Uil
J J
JJ
Mulder
C J
CJ
D000328:Adult; D000368:Aged; D002446:Celiac Disease / Q000188:drug therapy* / Q000473:pathology; D016572:Cyclosporine / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D007413:Intestinal Mucosa / Q000187:drug effects / Q000648:ultrastructure; D007421:Intestine, Small / Q000187:drug effects / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012008:Recurrence; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D016572:Cyclosporine