title: Long-term results of low-dose intravenous ciclosporin for acute severe ulcerative colitis.
abstract: BACKGROUND
  Intravenous ciclosporin for acute, severe colitis is usually administered in a dose of 4 mg/kg/day, with concurrent intravenous steroids. This is associated with considerable morbidity. We have been using a low-dose regimen, most commonly without concurrent steroids, for seven years, and present the outcome.
  
  
  METHODS
  Records of all patients admitted for severe ulcerative colitis, treated by one physician over seven years, were reviewed.
  
  
  RESULTS
  Thirty-one patients received low-dose intravenous ciclosporin (2 mg/kg/day) for a median 8 days. Eleven early patients received concurrent intravenous corticosteroids. Three patients had hypertension requiring dose reduction, one elevated creatinine and one elevated liver enzymes (all transient), and four experienced infection (two arm cellulitis, one perianal abscess, one post-operative wound infection). Twenty-four patients (77%) avoided urgent colectomy, and were discharged on oral ciclosporin and azathioprine. After a median 18 months (range 3-77), 14 patients (45% of total) avoided colectomy, of whom eight had flares responding to medical therapy and two had persistent, mildly active disease.
  
  
  CONCLUSIONS
  Low-dose intravenous ciclosporin (2 mg/kg/day), usually used as a monotherapy and followed by azathioprine, achieves similar long-term efficacy to higher dose ciclosporin combined with steroids in severe acute ulcerative colitis. Morbidity appears to be low.
authors.affiliation: Department of Medicine, St Mark's Hospital, London, UK.
authors.forename: C K
authors.initials: CK
authors.lastname: Rayner
authors.forename: G
authors.initials: G
authors.lastname: McCormack
authors.forename: A V
authors.initials: AV
authors.lastname: Emmanuel
authors.forename: M A
authors.initials: MA
authors.lastname: Kamm
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D016572:Cyclosporine / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D019233:Retreatment; D016896:Treatment Outcome
chemical_list: D016572:Cyclosporine