Audit of cyclosporin use in inflammatory bowel disease: limited benefits, numerous side-effects.
BACKGROUND
The failure of standard treatments for inflammatory bowel disease (IBD) has led to the use of immuno-modulatory therapy. Most reports of the use of cyclosporin are from single specialist centres.


OBJECTIVE
To survey the use of cyclosporin in IBD in Bristol's three teaching hospitals.


METHODS
Over a 4-year period, all patients receiving cyclosporin for IBD were identified and the following data recorded: diagnosis, duration of disease, initial treatment, date initiated, dose of cyclosporin, side-effects, initial clinical response, and current patient status.


RESULTS
Thirty-three patients were identified, of whom 26 had ulcerative colitis (UC), six had Crohn's disease and one had indeterminant colitis. The most frequent indication was as 'rescue' therapy in acute severe UC. The overall initial response rate was 63%, but this was only maintained in 30% long-term patients, with over half of them reporting side-effects. Four patients had life threatening side-effects.


CONCLUSIONS
Although the initial response rates are encouraging, the long-term results are poor and at the expense of a high incidence of side-effects. We feel that the use of cyclosporin in IBD should be reconsidered until more information from randomized controlled studies becomes available.
Dept of Gastroenterology, Gloucestershire Royal Hospital, UK.
N
N
Haslam
S D
SD
Hearing
C S
CS
Probert
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D008875:Middle Aged; D012189:Retrospective Studies
D007166:Immunosuppressive Agents; D016572:Cyclosporine