Cyclosporin in the treatment of adults with refractory coeliac disease - an open pilot study

Aim: To evaluate the effect of cyclosporin treatment on clinical and histol ogical parameters in adult patients with refractory coeliac disease. Methods: Thirteen patients were treated with oral cyclosporin for 2 months, aiming at serum levels of 100-200 ng/mL. Seven extended medication intake up to a maximum of 12 months. Before and after treatment, clinical paramete rs were monitored and small intestinal biopsies taken. Ten of 13 patients w ere typed for HLA-DQA1 and -DQB1 alleles. Results: Eight of 13 patients responded histologically to cyclosporin treat ment. Normalization of villi was demonstrated in five patients, three after prolonged treatment. Eight patients reported a clinical response, of whom six had concomitant histological improvement. No serious side-effects of cy closporin were noticed. Nine of 10 patients who were immunogenetically type d carried the coeliac disease associated serologic DQ2 markers, one carried neither DQ2 nor DQ8 markers. Conclusion: In our study group of 13 adult refractory coeliac disease patie nts, cyclosporin in therapeutic doses induced a histological improvement in eight patients (61%), in five of whom (38%) normalization of villi was dem onstrated. Thus, we believe that cyclosporin is a therapeutic option in ref ractory coeliac disease, although we could not confirm earlier reports of u nconditional successful treatment.