CYCLOSPORINE IN PATIENTS WITH INFLAMMATORY BOWEL-DISEASE REFRACTORY TO STEROID-THERAPY

About eighty percent of patients with severe ulcerative colitis refrac tory to steroids are responsive to intravenous cyclosporine therapy wi thin a few days. However, no controlled data are available on intraven ous cyclosporine therapy in steroid refractory Crohn's disease. In thi s study 7 patients with severe ulcerative colitis and 4 patients with active Crohn's disease unresponsive to prednisone were treated with hi gh dose intravenous cyclosporine. A response was estimated by a decrea se of Crohn's disease activity index (Best) and colitis activity index (Rachmilewitz). Six of 7 patients with ulcerative colitis showed a si gnificant decrease in colitis activity index tinder before therapy: 15 +/-2; one week later: 7+/-1; p<0.001). In these patients prednisone co uld be tapered to a dose less than 20mg/day within 6 months during ora l cyclosporine and concomitant azathioprine therapy. Cyclosporine medi cation was withdrawn within a few weeks and the clinical response coul d be preserved for another 6 months, In 3 of 4 patients with Crohn's d isease intravenous cyclosporine led to a temporary improvement of the Crohn's disease activity index (before treatment: 343 +/- 43, after on e week: 194 +/- 20; p<0.05). Nevertheless, all of these patients had a n early relapse under oral cyclosporine therapy. Our data confirm the efficacy of intravenous cyclosporine as a rapid acting drug for severe ulcerative colitis. Maintenance therapy with azathioprine preserved t he clinical response for one year. In patients with steroid refractory Crohn's disease intravenous cyclosporine showed only a short term eff ect.