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.
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: Fabian Schnitzler; Herma Fidder; Marc Ferrante; Maja Noman; Ingrid Arijs; Gert Van Assche; Ilse Hoffman; Kristel Van Steen; Séverine Vermeire; Paul Rutgeerts Journal: Inflamm Bowel Dis Date: 2009-09 Impact factor: 5.325
Authors: Tamás Molnár; Klaudia Farkas; Zoltán Szepes; Ferenc Nagy; Mónika Szűcs; Tibor Nyári; Anita Bálint; Tibor Wittmann Journal: United European Gastroenterol J Date: 2014-04 Impact factor: 4.623
Authors: Sasha R Fehily; Aysha H Al-Ani; Jonathan Abdelmalak; Clarissa Rentch; Eva Zhang; Justin T Denholm; Douglas Johnson; Siew C Ng; Vishal Sharma; David T Rubin; Peter R Gibson; Britt Christensen Journal: Aliment Pharmacol Ther Date: 2022-05-20 Impact factor: 9.524
Authors: F Scaldaferri; V Petito; L Lopetuso; G Bruno; V Gerardi; G Ianiro; A Sgambato; A Gasbarrini; G Cammarota Journal: Mediators Inflamm Date: 2013-05-08 Impact factor: 4.711