The effect of cyclosporin was evaluated in six patients with severe ul
cerative colitis not responding to at least 8 days of standard therapy
with intravenous corticosteroids. Cyclosporin (5-7.5 mg/kg/day intrav
enously) was added while steroid therapy was continued. Five of 6 pati
ents responded after a mean of 7 days and colectomy was not necessary.
After 4 weeks three patients achieved clinical remission or had mild
symptoms and were weaned from cyclosporin and corticosteroids without
exacerbation within the next 7-15 months. Two patients improved and th
ey were put on oral cyclosporin. One of them relapsed after 2 weeks an
d then responded to high dose corticosteroids. This patient is doing w
ell at 8 months of followup on azathioprine and steroids. One patient
stopped oral cyclosporin after 3 months abruptly and then had a relaps
e. He subsequently improved while refusing any medical therapy. Side e
ffects of cyclosporin occurred in 2 patients but were mild and self li
mited and did not necessitate discontinuation of the drug. Cyclosporin
appears to be effective in a large portion of patients with severe ul
cerative colitis who failed to improve on corticosteroids and in whom
colectomy would otherwise be considered.