| 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. | |
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MedLine Citation:
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PMID: 20614157 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article Date: 2010-07-08 |
Journal Detail:
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Title: Journal of gastroenterology Volume: 45 ISSN: 1435-5922 ISO Abbreviation: J. Gastroenterol. Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-11-12 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9430794 Medline TA: J Gastroenterol Country: Japan |
Other Details:
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Languages: eng Pagination: 1129-37 Citation Subset: IM |
Affiliation:
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Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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