INTRAVENOUS CYCLOSPORINE AS RESCUE THERAPY IN SEVERE ULCERATIVE-COLITIS - TIME FOR A REAPPRAISAL

Background Intravenous cyclosporin is the only new therapy in recent y ears to have made a significant impact on the management of acute seve re ulcerative colitis (UC), It is increasingly recommended for use in patients who prove refractory to the standard regimen of intravenous ( i.v,) and rectal hydrocortisone but do not warrant immediate surgery. This practice is based on uncontrolled and controlled studies which su ggest a short-term efficacy of 80% and long-term efficacy of 60% in av oiding colectomy, Aim The aim of this study was to assess the short-an d long-term efficacy of i,v, cyclosporin in patients admitted to our h ospital with acute severe ulcerative colitis refractory to i.v. steroi ds, over a 6-year period. Method A retrospective survey of patients ad mitted to the John Radcliffe Hospital, Oxford, with acute severe UC ov er a 6-year period (1991-97) was performed. Truelove and Witts criteri a for acute severe UC were satisfied by 216 patients. Results The stan dard regimen achieved remission in 132 patients (61%), Of the 84 patie nts who failed to respond, 34 (40%) proceeded directly to colectomy wh ilst 50 received cyclosporin (4 mg/kg by continuous slow infusion), Re mission was achieved by i,v. cyclosporin in 28/50 (56%) patients who w ere subsequently transferred to oral cyclosporin (5 mg/kg), However, 8 /28 (29%) who initially responded later relapsed after discharge from hospital acid underwent colectomy. The short-term efficacy of 56% ther efore falls to 40% in the longer term (mean follow-up of 19 months). C onclusion This is the largest survey to date of patients with refracto ry severe UC treated with i,v, cyclosporin. The findings confirm the p otential value of i,v, cyclosporin in severe UC but its effectiveness in clinical practice is less dramatic than previously reported. (C) 19 98 Lippincott-Raven Publishers.