title: Effects of oral tacrolimus as a rapid induction therapy in ulcerative colitis.
abstract: OBJECTIVE
  To determine the efficacy and safety of rapid induction therapy with oral tacrolimus without a meal in steroid-refractory ulcerative colitis (UC) patients.
  
  
  METHODS
  This was a prospective, multicenter, observational study. Between May 2010 and August 2012, 49 steroid-refractory UC patients (55 flare-ups) were consecutively enrolled. All patients were treated with oral tacrolimus without a meal at an initial dose of 0.1 mg/kg per day. The dose was adjusted to maintain trough whole-blood levels of 10-15 ng/mL for the first 2 wk. Induction of remission at 2 and 4 wk after tacrolimus treatment initiation was evaluated using Lichtiger's clinical activity index (CAI).
  
  
  RESULTS
  The mean CAI was 12.6 ± 3.6 at onset. Within the first 7 d, 93.5% of patients maintained high trough levels (10-15 ng/mL). The CAI significantly decreased beginning 2 d after treatment initiation. At 2 wk, 73.1% of patients experienced clinical responses. After tacrolimus initiation, 31.4% and 75.6% of patients achieved clinical remission at 2 and 4 wk, respectively. Treatment was well tolerated.
  
  
  CONCLUSIONS
  Rapid induction therapy with oral tacrolimus shortened the time to achievement of appropriate trough levels and demonstrated a high remission rate 28 d after treatment initiation. Rapid induction therapy with oral tacrolimus appears to be a useful therapy for the treatment of refractory UC.
authors: Ken Kawakami, Takuya Inoue, Mitsuyuki Murano, Ken Narabayashi, Sadaharu Nouda, Kumi Ishida, Yosuke Abe, Eiji Umegaki, Kazuhide Higuchi, Second Department of Internal Medicine, Osaka Medical College, Osaka 569-8686, Japan.
authors: Ken
authors: K
authors: Kawakami
authors: Ken Kawakami, Takuya Inoue, Mitsuyuki Murano, Ken Narabayashi, Sadaharu Nouda, Kumi Ishida, Yosuke Abe, Eiji Umegaki, Kazuhide Higuchi, Second Department of Internal Medicine, Osaka Medical College, Osaka 569-8686, Japan.
authors: Takuya
authors: T
authors: Inoue
authors: Ken Kawakami, Takuya Inoue, Mitsuyuki Murano, Ken Narabayashi, Sadaharu Nouda, Kumi Ishida, Yosuke Abe, Eiji Umegaki, Kazuhide Higuchi, Second Department of Internal Medicine, Osaka Medical College, Osaka 569-8686, Japan.
authors: Mitsuyuki
authors: M
authors: Murano
authors: Ken Kawakami, Takuya Inoue, Mitsuyuki Murano, Ken Narabayashi, Sadaharu Nouda, Kumi Ishida, Yosuke Abe, Eiji Umegaki, Kazuhide Higuchi, Second Department of Internal Medicine, Osaka Medical College, Osaka 569-8686, Japan.
authors: Ken
authors: K
authors: Narabayashi
authors: Ken Kawakami, Takuya Inoue, Mitsuyuki Murano, Ken Narabayashi, Sadaharu Nouda, Kumi Ishida, Yosuke Abe, Eiji Umegaki, Kazuhide Higuchi, Second Department of Internal Medicine, Osaka Medical College, Osaka 569-8686, Japan.
authors: Sadaharu
authors: S
authors: Nouda
authors: Ken Kawakami, Takuya Inoue, Mitsuyuki Murano, Ken Narabayashi, Sadaharu Nouda, Kumi Ishida, Yosuke Abe, Eiji Umegaki, Kazuhide Higuchi, Second Department of Internal Medicine, Osaka Medical College, Osaka 569-8686, Japan.
authors: Kumi
authors: K
authors: Ishida
authors: Ken Kawakami, Takuya Inoue, Mitsuyuki Murano, Ken Narabayashi, Sadaharu Nouda, Kumi Ishida, Yosuke Abe, Eiji Umegaki, Kazuhide Higuchi, Second Department of Internal Medicine, Osaka Medical College, Osaka 569-8686, Japan.
authors: Yosuke
authors: Y
authors: Abe
authors: Ken Kawakami, Takuya Inoue, Mitsuyuki Murano, Ken Narabayashi, Sadaharu Nouda, Kumi Ishida, Yosuke Abe, Eiji Umegaki, Kazuhide Higuchi, Second Department of Internal Medicine, Osaka Medical College, Osaka 569-8686, Japan.
authors: Koji
authors: K
authors: Nogami
authors: Ken Kawakami, Takuya Inoue, Mitsuyuki Murano, Ken Narabayashi, Sadaharu Nouda, Kumi Ishida, Yosuke Abe, Eiji Umegaki, Kazuhide Higuchi, Second Department of Internal Medicine, Osaka Medical College, Osaka 569-8686, Japan.
authors: Nobuyuki
authors: N
authors: Hida
authors: Ken Kawakami, Takuya Inoue, Mitsuyuki Murano, Ken Narabayashi, Sadaharu Nouda, Kumi Ishida, Yosuke Abe, Eiji Umegaki, Kazuhide Higuchi, Second Department of Internal Medicine, Osaka Medical College, Osaka 569-8686, Japan.
authors: Hirokazu
authors: H
authors: Yamagami
authors: Ken Kawakami, Takuya Inoue, Mitsuyuki Murano, Ken Narabayashi, Sadaharu Nouda, Kumi Ishida, Yosuke Abe, Eiji Umegaki, Kazuhide Higuchi, Second Department of Internal Medicine, Osaka Medical College, Osaka 569-8686, Japan.
authors: Kenji
authors: K
authors: Watanabe
authors: Ken Kawakami, Takuya Inoue, Mitsuyuki Murano, Ken Narabayashi, Sadaharu Nouda, Kumi Ishida, Yosuke Abe, Eiji Umegaki, Kazuhide Higuchi, Second Department of Internal Medicine, Osaka Medical College, Osaka 569-8686, Japan.
authors: Eiji
authors: E
authors: Umegaki
authors: Ken Kawakami, Takuya Inoue, Mitsuyuki Murano, Ken Narabayashi, Sadaharu Nouda, Kumi Ishida, Yosuke Abe, Eiji Umegaki, Kazuhide Higuchi, Second Department of Internal Medicine, Osaka Medical College, Osaka 569-8686, Japan.
authors: Shiro
authors: S
authors: Nakamura
authors: Ken Kawakami, Takuya Inoue, Mitsuyuki Murano, Ken Narabayashi, Sadaharu Nouda, Kumi Ishida, Yosuke Abe, Eiji Umegaki, Kazuhide Higuchi, Second Department of Internal Medicine, Osaka Medical College, Osaka 569-8686, Japan.
authors: Tetsuo
authors: T
authors: Arakawa
authors: Ken Kawakami, Takuya Inoue, Mitsuyuki Murano, Ken Narabayashi, Sadaharu Nouda, Kumi Ishida, Yosuke Abe, Eiji Umegaki, Kazuhide Higuchi, Second Department of Internal Medicine, Osaka Medical College, Osaka 569-8686, Japan.
authors: Kazuhide
authors: K
authors: Higuchi
mesh_terms: D000284:Administration, Oral; D000328:Adult; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000188:drug therapy*; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D060828:Induction Chemotherapy; D007564:Japan; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012074:Remission Induction; D016559:Tacrolimus / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus
keywords: Inflammatory bowel disease; Rapid induction therapy; Steroid-refractory ulcerative colitis; Tacrolimus; Ulcerative colitis