title: Rapid endoscopic improvement is important for 1-year avoidance of colectomy but not for the long-term prognosis in cyclosporine A treatment for ulcerative colitis.
abstract: BACKGROUND
  Intravenous (IV) cyclosporine A (CSA) is one of the treatments of choice for patients with steroid-refractory severe ulcerative colitis (UC). In this study, we evaluated the overall experience with CSA treatment in UC patients, from their initial response to long-term prognosis.
  
  
  METHODS
  The medical records of 72 patients admitted to our hospital with a severe UC flare-up and treated with IV CSA between November 1996 and October 2008 were reviewed retrospectively. The initial response to CSA was assessed using a clinical activity index, and colectomy was assigned as the endpoint for the long-term prognosis.
  
  
  RESULTS
  Overall, 53 of 72 (73.6%) patients responded initially to CSA. We could not determine any specific parameters that predicted an initial response. A life-table analysis for all patients revealed that 54.4% of patients required a colectomy within 11 years. The long-term risk of surgery was associated with a shorter disease duration, history of adverse reactions against medications and lack of immunomodulator use. In addition, endoscopic improvement at day 14 was associated with colectomy at 1 year, but not with the long-term prognosis.
  
  
  CONCLUSIONS
  Although CSA can exert high initial efficacy for severe attacks of UC, >50% of patients who relapse require a colectomy. Specifically, mucosal healing evaluated by endoscopy was associated with the 1-year colectomy rate. In contrast, a history of adverse drug reactions was correlated with the long-term colectomy rate. Therefore, we propose that treatment of severe UC with CSA requires consideration of both initial remission and long-term maintenance as management goals.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Makoto
authors.initials: M
authors.lastname: Naganuma
authors.forename: Susumu
authors.initials: S
authors.lastname: Okamoto
authors.forename: Tadakazu
authors.initials: T
authors.lastname: Hisamatsu
authors.forename: Nagamu
authors.initials: N
authors.lastname: Inoue
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ichikawa
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Takayama
authors.forename: Riko
authors.initials: R
authors.lastname: Saito
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Sujino
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Ogata
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Iwao
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Hibi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003082:Colectomy / Q000379:methods*; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D003113:Colonoscopy / Q000379:methods; D016572:Cyclosporine / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D007413:Intestinal Mucosa / Q000473:pathology; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine