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Cyclosporine is Safe and Effective in Patients With Severe Ulcerative Colitis.
MedLine Citation:
PMID:  20679905     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: Cyclosporine (CSA) is effective in the short-term for severe, steroid refractory ulcerative colitis; but its use has been limited by concerns about safety and colectomy-sparing rates. The aim of this study was to assess the long-term colectomy-sparing effects and safety of CSA in patients hospitalized for ulcerative colitis.
METHODS: Review of the patients who underwent intravenous CSA for ulcerative colitis between 1989 and 2003.
RESULTS: A total of 71 patients with severe ulcerative colitis were treated with IV CSA. The median length of follow-up was 1.5 years (mean=3 y) (range 1 mo to 14 y) (IQR 0.6 to 4.6). Eighty-five percent (60/71) of patients responded to IV CSA and were discharged on oral CSA. Of these 60 patients, 26 were transitioned from CSA to 6MP. Of the 26 patients who were transitioned from CSA to 6MP, only 1 patient (4%) ultimately required colectomy; whereas colectomy was carried out in 76% (26/34) of the patients who were not transitioned from CSA to 6MP. Only concomitant 6MP therapy was associated with a reduced risk of colectomy (OR 0.01, 95% CI 0.001, 0.09, P<0.0001) on long-term follow-up in this group. Cumulative colectomy rates for the entire cohort were 39% (28/71) at 1 year, 42% (30/71) at 2 years, and 46% (33/71) at 5 years. Side effects were noted in two-thirds of the patients, the majority of which were mild.
CONCLUSION: CSA is an effective therapy for severe ulcerative colitis. Long-term efficacy is improved with transition to 6MP. Adverse events with CSA are frequent, but most are mild.
Authors:
Adam S Cheifetz; Joshua Stern; Sagar Garud; Eric Goldstein; Lisa Malter; Alan C Moss; Daniel H Present
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of clinical gastroenterology     Volume:  45     ISSN:  1539-2031     ISO Abbreviation:  J. Clin. Gastroenterol.     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-01-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7910017     Medline TA:  J Clin Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  107-12     Citation Subset:  IM    
Affiliation:
*Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA †Division of Gastroenterology, Department of Medicine, The Mount Sinai Medical Center, New York, NY.
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