Cyclosporine therapy in inflammatory bowel disease - Short-term and long-term results

Intravenous cyclosporine therapy followed by oral cyclosporine therapy redu ce the need for urgent surgery in steroid-refractory inflammatory bowel dis ease (IBD). Our objective is to report short- and long-term results of cycl osporine therapy in IBD patients. Thirteen patients with steroid-refractory IBD, seven patients with ulcerative colitis (UC), and six patients with Cr ohn's disease (CD) were treated with intravenous cyclosporine (4 mg/kg/day) for a mean period of 11.4 +/- 2.8 days (range, 4-15 days). Subsequently th e patients were started on oral cyclosporine (8 mg/kg/day) and followed for a mean of 10.3 +/- 10 months (range, 1-30 months). Twelve patients respond ed to intravenous cyclosporine therapy. One patient with UC developed sepsi s on the fourth day of intravenous cyclosporine therapy and needed urgent c olectomy. Nine of 12 initial responders (6 patients with UC and 3 patients with CD) relapsed during follow-up despite oral cyclosporine and underwent elective surgery. One patient with CD relapsed 3 months after discontinuati on of oral cyclosporine. Only two patients with CD are in long-term remissi on. There were no long-term side effects in any of the 13 treated patients. In conclusion, intravenous cyclosporine was effective in inducing remissio n or significant improvement in 12 of 13 patients with steroid-refractory I BD. However, with subsequent oral cyclosporine the remission could be maint ained only for a short while. Each of the six patients with UC needed colec tomy and three of the five patients with CD had intestinal resection within 12 months despite oral cyclosporine therapy.