Intravenous cyclosporin in ulcerative colitis: A five-year experience

OBJECTIVE: Cyclosporin (CSA) is a promising alternative for patients with s evere steroid-refractory ulcerative colitis (UC) previously facing only sur gical options. Concerns over the long term efficacy and side effects result ed in this investigation of the University of Chicago's 5-yr CSA experience in these patients. METHODS: All steroid-refractory severe ulcerative colitis (UC) patients tre ated with TV CSA from 1991 to 1995 were identified by using the university' s IBD database, with additional information from patient charts and physici an files. RESULTS: A total of 42 patients with severe UC unresponsive to IV steroids were treated with TV CSA (4 mg/kg/day). Of 42 patients, 36 (86%) responded; 31 were continued on oral CSA (8 mg/kg/day) for an overall mean of 20 wk. Ten initial CSA responders had colectomies after a mean of 6 months. Of the 36 initial responders, 25 (69%) also received 6-mercaptopurine (6-MP) or a zathioprine (aza), and CSA and steroids were tapered. A total of 20% requir ed colectomy, vs 45% of those not receiving 6MP/aza. In all, 62% of all pat ients, 72% of initial CSA responders, and 80% of initial CSA responders rec eiving 6MP/aza have avoided colectomy, with a life table analysis of "nonco lectomy survival" of 58%, 70%, and 71%, respectively, at 5.5 yr. All colect omies occurred within 18 months of CSA initiation. Complications, resulting in CSA discontinuation in six patients, were all reversible, with complete recovery. CONCLUSIONS: CSA successfully allows most severe steroid resistant UC patie nts to retain their colons, and provides time for "elective" colectomy in o thers, especially if 6MP/ aza are also given. Careful monitoring for side e ffects, including PCP prophylaxis, should be part of the treatment protocol . (Am J Gastroenterol 1999;94:1587-1592. (C) 1999 by Am. Cell. of Gastroent erology).