Lisa Sharkey1, Fran Bredin, Allison Nightingale, Miles Parkes. 1. Department of Gastroenterology, Box 201A, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom. lisasharkey@doctors.org.uk
Abstract
BACKGROUND AND AIMS: Approximately 15% of patients with ulcerative colitis will have a severe flare requiring hospitalisation at some stage. For those who fail to respond to intravenous steroids Cyclosporin A (CyA) therapy is one option. We have evaluated the management of such patients in our centre and present the long term colectomy avoidance rates. METHODS: 38 consecutive patients receiving CyA for an acute, steroid-refractory flare of colitis were retrieved from our database. Records were unavailable for 2 patients and 2 received therapy twice, hence 38 episodes were analysed. RESULTS: 24/36 patients were male; median age 37 years. On admission 20 patients were taking oral steroids; 8 were taking a thiopurine and 7 patients were on no treatment. CyA was started a median of 8 days after admission (range 1-28) and most patients (32/38) received this orally at doses of 4.5-8.3mg/kg. 15 patients have undergone colectomy, 11 of these during the same admission for lack of response to CyA. Of the patients who were discharged without surgery, 84% have still not required colectomy after a median follow-up of 3.8 years. Adverse effects were mostly minor, though two patients developed neutropenia on dual immunosuppression. CONCLUSIONS: CyA can be administered orally with good tolerability. We use it as a bridging therapy to Azathioprine. In our population, 84% of those who responded to CyA have not required surgery.
BACKGROUND AND AIMS: Approximately 15% of patients with ulcerative colitis will have a severe flare requiring hospitalisation at some stage. For those who fail to respond to intravenous steroidsCyclosporin A (CyA) therapy is one option. We have evaluated the management of such patients in our centre and present the long term colectomy avoidance rates. METHODS: 38 consecutive patients receiving CyA for an acute, steroid-refractory flare of colitis were retrieved from our database. Records were unavailable for 2 patients and 2 received therapy twice, hence 38 episodes were analysed. RESULTS: 24/36 patients were male; median age 37 years. On admission 20 patients were taking oral steroids; 8 were taking a thiopurine and 7 patients were on no treatment. CyA was started a median of 8 days after admission (range 1-28) and most patients (32/38) received this orally at doses of 4.5-8.3mg/kg. 15 patients have undergone colectomy, 11 of these during the same admission for lack of response to CyA. Of the patients who were discharged without surgery, 84% have still not required colectomy after a median follow-up of 3.8 years. Adverse effects were mostly minor, though two patients developed neutropenia on dual immunosuppression. CONCLUSIONS:CyA can be administered orally with good tolerability. We use it as a bridging therapy to Azathioprine. In our population, 84% of those who responded to CyA have not required surgery.
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: I Ordás; E Domènech; M Mañosa; V García-Sánchez; E Iglesias-Flores; M Peñalva; A Cañas-Ventura; O Merino; F Fernández-Bañares; F Gomollón; M Vera; A Gutiérrez; E Garcia-Planella; M Chaparro; M Aguas; E Gento; F Muñoz; M Aguirresarobe; C Muñoz; L Fernández; X Calvet; C E Jiménez; M A Montoro; A Mir; M L De Castro; M F García-Sepulcre; F Bermejo; J Panés; M Esteve Journal: Am J Gastroenterol Date: 2017-07-04 Impact factor: 10.864