COMBINED USE OF CYCLOSPORINE AND AZATHIOPRINE OR 6-MERCAPTOPURINE IN PEDIATRIC INFLAMMATORY BOWEL-DISEASE

The aim of this study was to assess whether in steroid-resistant patie nts with pediatric inflammatory bowel disease (IBD) a combination of c yclosporine and azathioprine (or 6-mercaptopurine) could induce remiss ion and subsequently permit maintenance on azathioprine/6-mercaptopuri ne as the sole immunosuppressive agent. Two boys and six girls (six wi th ulcerative colitis and two with Crohn's disease; ages 3-17 years) r eceived 100-200 mu g/kg/day cyclosporine intravenously and then 4-10 m g/kg/day orally. Doses were adjusted to achieve trough serum cyclospor ine levels of 100-200 mu/L (Abbott's TDX assay). Seven of the eight pa tients received azathioprine/6-mercaptopurine, and all were given a 5- aminosalicylate preparation and corticosteroids. The latter drugs were continued and then tapered off as clinical status allowed. Cyclospori ne was continued for 3-10 months in those who responded. In seven of e ight patients, there was a rapid clinical response; one patient showed a transient response, but recurrent bleeding led to total colectomy 9 days after starting cyclosporine. Of the seven responders, three were able to discontinue prednisone and cyclosporine and are doing well on azathioprine at long-term follow-up (2-5 years). One who did not rece ive azathioprine/6-mercaptopurine maintained remission for 2 years aft er cyclosporine was stopped, one experienced a disease flare-up 5 mont hs after start of cyclosporine treatment and required colectomy, one w ho did not tolerate 6-mercaptopurine had a flare-up during cyclosporin e tapering and underwent surgery at 6 months, and one started to flare up with cyclosporine tapering at 6 months and was scheduled for surge ry. No significant complications of treatment were observed. Seven pat ients had an initial response and four of them have so far not require d surgery. These preliminary findings suggest that azathioprine/6-merc aptopurine can be used safely to maintain cyclosporine-induced remissi on in children with IBD.