title: Oral tacrolimus for pediatric steroid-resistant ulcerative colitis.
abstract: BACKGROUND
  Ulcerative colitis (UC) occurring during childhood is generally extensive and is associated with severe flares that may require intravenous steroid treatment. In cases of corticosteroid resistance is necessary to introduce a second-line treatment to avoid or delay surgery.
  
  
  OBJECTIVE
  To describe the efficacy and safety of oral tacrolimus for the treatment of severe steroid-resistant UC.
  
  
  METHODS
  We performed a retrospective study that included all patients under age 18 suffering from severe steroid-resistant UC treated with oral tacrolimus during the period January 1998 to October 2012 and with a follow-up period after treatment of 24 months or more.
  
  
  RESULTS
  A total of ten patients were included. The age at baseline was 9.4±4.9 years, and the time from diagnosis was 1.3 months (IQR, 1-5.7). Seven of the patients were in their first flare of disease. All of them received an oral dose of 0.12 mg/kg/day of tacrolimus divided in two doses. Trough plasma levels of tacrolimus were maintained between 4 and 13 ng/ml. Response was seen in 5/10 patients at 12 months, colectomy was eventually performed in 60% of patients during the follow-up period.
  
  
  CONCLUSIONS
  Tacrolimus is useful in inducing remission in patients with severe steroid-resistant UC, preventing or delaying colectomy, and allowing the patient and family to prepare for a probable surgery. Tacrolimus may also be used as a treatment bridge for corticosteroid-dependent patients until the new maintenance therapy takes effect.
authors.affiliation: Pediatric Gastroentrology and Nutrition Unit, Hospital Materno Infantil, Málaga, Spain. Electronic address: victor.navas@gmail.com.
authors.forename: V M
authors.initials: VM
authors.lastname: Navas-López
authors.affiliation: Pediatric Gastroentrology and Nutrition Unit, Hospital Materno Infantil, Málaga, Spain. Electronic address: javierblascoalonso@yahoo.es.
authors.forename: J
authors.initials: J
authors.lastname: Blasco Alonso
authors.affiliation: Pediatric Gastroentrology and Nutrition Unit, Hospital Materno Infantil, Málaga, Spain. Electronic address: serranonieto@hotmail.com.
authors.forename: M J
authors.initials: MJ
authors.lastname: Serrano Nieto
authors.affiliation: Pediatric Gastroentrology and Nutrition Unit, Hospital Materno Infantil, Málaga, Spain. Electronic address: currogiron@gmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Girón Fernández-Crehuet
authors.affiliation: Pediatric Gastroentrology and Nutrition Unit, Hospital Materno Infantil, Málaga, Spain. Electronic address: mdargos@gmail.com.
authors.forename: M D
authors.initials: MD
authors.lastname: Argos Rodriguez
authors.affiliation: Pediatric Gastroentrology and Nutrition Unit, Hospital Materno Infantil, Málaga, Spain. Electronic address: csierra@wanadoo.es.
authors.forename: C
authors.initials: C
authors.lastname: Sierra Salinas
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000601:surgery; D004351:Drug Resistance; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D008297:Male; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013256:Steroids / Q000627:therapeutic use; D016559:Tacrolimus / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids; D016559:Tacrolimus
keywords: Children;; Paediatric; Steroids;; Surgery;; Tacrolimus;; Ulcerative colitis;