SHORT-TERM AND LONG-TERM EFFICACY OF CYCLOSPORINE ADMINISTRATION IN PATIENTS WITH ACUTE SEVERE ULCERATIVE-COLITIS

Cyclosporin (CsA) has been proposed in the management of patients with acute ulcerative colitis (UC) in whom standard therapy failed and who were candidates for colectomy. Seven academic hospitals contributed t o this retrospective study that included 29 patients (median age: 33 y . (15-74 y.); 12 females and 17 males). The median duration of the dis ease was 4 y. (0.3 to 33 y.). Before initiating CsA, patients were unr esponsive to treatment including iv corticosteroids (n = 29), 5-ASA or salazopyrine (n = 19), azathioprine (n = 3), antibiotics (n = 14). Th e iv mean dose was 4 mg/kg/day and was adapted to blood level. Concomi tant treatment included corticosteroids (n = 27). The median duration of iv CsA administration was 10 days (4 to 41 days). At the end of CsA administration, a global improvement was described in 20 patients whi le a surgery had to be performed immediately in 8 patients because of exacerbation of symptoms (n = 7) or perforation (n = 1). One other pat ient (74 y.) died because of Pneumocystis carinii infection. For the r esponders, maintenance therapy included: tapering dose of steroids (n = 12), azathioprine (n = 12), 5-ASA or salazopyrine (n = 10), methotre xate (n = 1) or oral CsA (n = 11). The median duration of follow-up wa s 12 months (4 to 48 months). Among the 20 responders, 7 were subseque ntly referred for colectomy either electively (n = 3) or because of re currence of the disease (n = 4). Among the 12 patients treated by azat hioprine as a maintenance therapy, only 3 had to be referred for surge ry (25%). Among the 8 patients who did not receive azathioprine, 4 wer e subsequently referred for a colectomy (50%) (NS). In patients with a cute refractory UC who received CsA, the shortterm efficacy (avoidance of immediate colectomy) was obtained in 20 out of 29 patients (69%). However, after a median follow-up of 12 months, only 13 patients were colectomy free (45%).