INDUCTION OF REMISSION BY INTERFERON-ALPHA IN PATIENTS WITH CHRONIC ACTIVE ULCERATIVE-COLITIS

Objective: To ascertain whether treatment with interferon-alpha 2a (IF N-alpha 2a) can induce remission in patients with chronic active ulcer ative colitis. Study design: Prospective, open-label study. Setting: T he gastroenterology section of Ankara University School of Medicine, w hich is the regional referral centre for the city of Ankara. Study pop ulation: The study included 28 in-patients with established ulcerative colitis and tacking known pathogens. The diagnosis was confirmed usin g endoscopic, radiological and histological techniques. Patients enrol led in the study had previously shown resistance to 5-aminosalicylic a cid and steroids. Measurements: Disease activity was evaluated clinica lly and endoscopically. Laboratory parameters (erythrocyte sedimentati on rate, haematocrit, and serum albumin levels) were used as indirect markers of inflammatory status. After a 10 day washout period, patient s were treated with IFN-alpha 2a. Intervention: IFN-alpha 2a therapy s tarted with 3 MIU (one subcutaneous injection) and was increased to 6 MIU (one subcutaneous injection) and then 9 MIU three times a week (th ree subcutaneous injections every second day for 1 week) to habituate the patients and ensure early onset of action. The dose was then decre ased to 6 MIU (three injections every second day for 1 week) and maint ained at 3 MIU (three times a week) for 6-12 months. Results: Clinical ly, 71% per cent of the patients had severe and 29% moderate ulcerativ e colitis activity before the treatment. Five patients (18%) did not r espond to IFN-alpha 2a therapy within the first 2 months; two of them underwent total colectomy and the remaining three (11%) achieved late remission after prolonged IFN-alpha 2a therapy. Twenty-three (82%) pat ients responded to therapy with a fast improvement (within 15 days) an d were in complete clinical and endoscopic remission after 6 months of therapy. During the treatment period, four (14.2%) patients with pre- existing small haemorrhoids suffered from enlarged ulcerated and bleed ing external haemorrhoids, and flu-like symptoms were a common side ef fect. No adverse effects serious enough to necessitate discontinuation of the therapy were observed. Twenty-six (93%) patients were observed for more than 2 years without being given therapy and remained in ful l clinical and endoscopic remission during this period. Conclusion: In our opinion, IFN-alpha 2a is a well-tolerated, non-toxic, easily appl icable and outstanding drug, which could become the treatment of choic e for first-line therapy of chronic active ulcerative colitis, especia lly in patients who show resistance to other drugs.