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Rapid endoscopic improvement is important for 1-year avoidance of colectomy but not for the long-term prognosis in cyclosporine A treatment for ulcerative colitis.
MedLine Citation:
PMID:  20614157     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
BACKGROUND: Intravenous (IV) cyclosporine A (CSA) is one of the treatments of choice for patients with steroid-refractory severe ulcerative colitis (UC). In this study, we evaluated the overall experience with CSA treatment in UC patients, from their initial response to long-term prognosis.
METHODS: The medical records of 72 patients admitted to our hospital with a severe UC flare-up and treated with IV CSA between November 1996 and October 2008 were reviewed retrospectively. The initial response to CSA was assessed using a clinical activity index, and colectomy was assigned as the endpoint for the long-term prognosis.
RESULTS: Overall, 53 of 72 (73.6%) patients responded initially to CSA. We could not determine any specific parameters that predicted an initial response. A life-table analysis for all patients revealed that 54.4% of patients required a colectomy within 11 years. The long-term risk of surgery was associated with a shorter disease duration, history of adverse reactions against medications and lack of immunomodulator use. In addition, endoscopic improvement at day 14 was associated with colectomy at 1 year, but not with the long-term prognosis.
CONCLUSIONS: Although CSA can exert high initial efficacy for severe attacks of UC, >50% of patients who relapse require a colectomy. Specifically, mucosal healing evaluated by endoscopy was associated with the 1-year colectomy rate. In contrast, a history of adverse drug reactions was correlated with the long-term colectomy rate. Therefore, we propose that treatment of severe UC with CSA requires consideration of both initial remission and long-term maintenance as management goals.
Authors:
Taku Kobayashi; Makoto Naganuma; Susumu Okamoto; Tadakazu Hisamatsu; Nagamu Inoue; Hitoshi Ichikawa; Tetsuro Takayama; Riko Saito; Tomohisa Sujino; Haruhiko Ogata; Yasushi Iwao; Toshifumi Hibi
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Publication Detail:
Type:  Journal Article     Date:  2010-07-08
Journal Detail:
Title:  Journal of gastroenterology     Volume:  45     ISSN:  1435-5922     ISO Abbreviation:  J. Gastroenterol.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9430794     Medline TA:  J Gastroenterol     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  1129-37     Citation Subset:  IM    
Affiliation:
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan.
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