title: Efficacy of intravenous cyclosporin in moderately severe ulcerative colitis refractory to steroids.
abstract: OBJECTIVE
  The efficacy of intravenous cyclosporin (CSA) in acute severe ulcerative colitis (UC) is well established. The aim of this study was to evaluate its efficacy in moderately severe colitis refractory to steroids.
  
  
  METHODS
  Twenty-six patients (17 men, mean age 41 +/- 14 yr) with UC refractory to steroids treated with CSA were included in this study. Severity was defined according to Truelove criteria. A clinical activity score below 10 during 2 consecutive days defined clinical response.
  
  
  RESULTS
  According to Truelove criteria, all patients had moderate UC. CSA was administered IV at a mean daily dose of 3.7 +/- 0,5 mg/kg until response and then orally for 3.5 +/- 2.6 months. A clinical response was achieved in 20/26 patients (76,9%) within 5.7 +/- 2.8 days (5/6 failures were treated by proctocolectomy). During a follow-up of 27.8 +/- 20.8 months, relapse rate was 60% (12/20): 7 patients underwent proctocolectomy and 5 had clinical remission with CSA retreatment (N=4) and steroids (N=1). At the end of follow-up, 12 patients (46%) were in clinical remission, 12 (46%) required colectomy, 1 had chronic active UC and 1 was lost of follow-up. The probability to avoid surgery was 52% at 78 months. The only factor associated with avoidance of surgery was concomitant treatment with azathioprine (P=0.007). Ten reversible adverse events occurred in 9 patients.
  
  
  CONCLUSIONS
  This study shows that CSA is safe and effective in moderately severe steroid resistant UC. Concomitant treatment with azathioprine significantly decreases the rate of subsequent surgery. CSA may act as a "bridge" until the therapeutic action of azathioprine is achieved for maintenance treatment. These results should be further confirmed by a prospective controlled study.
authors.affiliation: Service d'Hépato-gastroentérologie, Hôpital Saint-André, Bordeaux.
authors.forename: Laurent
authors.initials: L
authors.lastname: Message
authors.forename: Arnaud
authors.initials: A
authors.lastname: Bourreille
authors.forename: David
authors.initials: D
authors.lastname: Laharie
authors.forename: André
authors.initials: A
authors.lastname: Quinton
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Galmiche
authors.forename: Hervé
authors.initials: H
authors.lastname: Lamouliatte
authors.forename: Afchine
authors.initials: A
authors.lastname: Alamdari
authors.forename: Frank
authors.initials: F
authors.lastname: Zerbib
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000601:surgery; D016572:Cyclosporine / Q000627:therapeutic use*; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000494:pharmacology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D016737:Proctocolectomy, Restorative; D012074:Remission Induction; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D001379:Azathioprine