Audit of cyclosporin use in inflammatory bowel disease: limited benefits, numerous side-effects

Background The failure of standard treatments for inflammatory bowel diseas e (IBD) has led to the use of immuno-modulatory therapy. Most reports of th e use of cyclosporin are from single specialist centres. Aim To survey the use of cyclosporin in IBD in Bristol's three teaching hos pitals. Patients and methods Over a 4-year period, all patients receiving cyclospor in for IBD were identified and the following data recorded: diagnosis, dura tion of disease, initial treatment, date initiated, dose of cyclosporin, si de-effects, initial clinical response, and current patient status. Results Thirty-three patients were identified, of whom 26 had ulcerative co litis (UC), six had Crohn's disease and one had indeterminant colitis. The most frequent indication was as 'rescue' therapy in acute severe UC, The ov erall initial response rate was 63%, but this was only maintained in 30% lo ng-term patients, with over half of them reporting side-effects. Four patie nts had life threatening side-effects. Conclusion Although the initial response rates are encouraging, the long-te rm results are poor and at the expense of a high incidence of side-effects. We feel that the use of cyclosporin in IBD should be reconsidered until mo re information from randomized controlled studies becomes available. (C) 20 00 Lippincott Williams & Wilkins.