Long-term outcome of treatment with intravenous cyclosporin in patients with severe ulcerative colitis.
OBJECTIVE
Iv cyclosporin A (CSA) is an effective therapy in patients with severe ulcerative colitis (UC). It remains unclear if this treatment affects the course of the disease in the long run. We investigated the long-term efficacy and safety in 86 patients with ulcerative colitis treated with i.v. CSA at our center.


METHODS
The records of all patients treated with i.v. CSA between 11/1992 and 11/2000 were reviewed.


RESULTS
Seventy-two of 86 patients (83.7%) responded to i.v. CSA therapy, administered for a mean of 9 +/- 2 days. Following the initial treatment, 69 patients (96%) were discharged on oral CSA with mean blood CSA concentrations of 192 +/- 55 ng/mL. Azathioprine was added in 64 (89%) patients. A second treatment with CSA was necessary in 11 patients; 1 patient received three courses of i.v. treatment. The duration of follow-up averaged 773 +/- 369 days. Patients who were responders but were still having certain symptoms at discharge had a higher incidence of colectomy during follow-up. Of all initial responders, 18 (25%) underwent colectomy after a mean interval of 178 +/- 141 days. The life-table predicts that of all treated patients, 55% will avoid a colectomy during a period of 3 years. Complications of CSA treatment were mostly reversible, but 3 patients (3.5%) died of opportunistic infections (1 of Pneumocystis carinii pneumonia and 2 of Aspergillus fumigatus pneumoniae). One patient with anaphylactic shock caused by the CSA solvent was successfully resuscitated.


CONCLUSIONS
CSA is an effective treatment of the majority of patients with severe attacks of UC, although the toxicity and even mortality associated with its use necessitates careful evaluation, selection, and follow-up.
Arts
Joris
J
Department of Internal Medicine, University Hospital, Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium.
D'Haens
Geert
G
Zeegers
Miranda
M
Van Assche
Gert
G
Hiele
Martin
M
D'Hoore
André
A
Penninckx
Freddy
F
Vermeire
Severine
S
Rutgeerts
Paul
P
D000328:Adult; D003082:Colectomy / Q000379:methods; D003093:Colitis, Ulcerative / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D016572:Cyclosporine / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
D016572:Cyclosporine