Ciclosporin for severe refractory colitis.
BACKGROUND
Intravenous ciclosporin is a promising alternative, rapidly effective, for patients with severe steroid-refractory colitis previously facing only surgical options, however its use is controversial because of the frequency of adverse effects and the doubt about the long-term response.


OBJECTIVE
This review will provide information on clinical pharmacology, clinical indications for use, methods of dose adjustment, monitoring of metabolites for efficacy and for potential side effects and the adverse event profile of ciclosporin in severe refractory colitis.


METHODS
Literature review.


RESULTS
Toxicity is dominated by opportunistic infections. Renal and neurotoxicity are also recognized. Risks of toxicity can be reduced by using lower doses, by oral microemulsion or by monotherapy without corticosteroids. The drug should not be continued for more than 3 to 6 months. As a bridge to other maintenance therapy such as azathioprine or 6-mercaptopurine ciclosporin can be an effective treatment.


CONCLUSIONS
CSA is a viable alternative to emergency colectomy in severe UC in the short term. Although these benefits are not maintained in all patients, more than a half will also avoid colectomy in the longer term. Careful selection and monitoring of patients, use of lower doses, and oral therapy will help to reduce side effects.
Service de gastro-entérologie, hôpital Habib Thameur.
Asma
A
Ouakaa-Kchaou
Dalila
D
Gargouri
Hela
H
Elloumi
Jamel
J
Kharrat
Abdeljabbar
A
Ghorbel
D003092:Colitis / Q000188:drug therapy*; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D012720:Severity of Illness Index
D007166:Immunosuppressive Agents; D016572:Cyclosporine