Cyclosporin for severe ulcerative colitis

Background: About one-third of patients with severe ulcerative colitis do n ot respond to conventional therapy and require urgent colectomy. It was rec ently shown that cyclosporin is effective in some of these patients. Objectives: To review the current experience of six hospitals in central Is rael that used cyclosporin in patients with severe ulcerative colitis. Methods: The files of all 32 patients treated with cyclosporin for corticos teroid-resistant ulcerative colitis were reviewed. Activity of disease was measured by a clinical activity, index colonoscopy and laboratory tests. Results: The average duration of treatment with intravenous cyclosporin was 12.7 days (range 9-28) after which the disease activity index dropped from an average of 14.22 to 4.74. The mean time for response was 7.5 days (4-14 ). Twelve patients (40%) required surgery within 6 months and another 6 pat ients (18.8%) were operated on after more than 6 months. Twelve patients (3 7%) maintained remission for at least 6 months and did not require surgery. In one patient treatment was stopped because of non-compliance and one was lost to follow-up. There were numerous side effects, but in only one case with neurotoxicity was treatment withdrawn. Conclusions: Cyclosporin is a relatively safe and effective treatment for s evere ulcerative colitis. It induced long-term remission in 37% of the pati ents, and in those who required surgery the treatment resulted in an improv ed clinical condition before the operation.