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High-dose intravenous cyclosporine in steroid refractory attacks of inflammatory bowel disease
C Hermida-Rodriguez1, J Cantero Perona, R Garcia-Valriberas
1Servicio de Aparato Digestivo, Hospital Universitario de la Princesa, Universidad Autonoma de Madrid, Spain.
Background/Aims:
To determin whether cyclosporine is effective in inducing remission in patients with severe active inflammatory bowel disease, refractory to steroids.
Methodology:
Twenty-three patients with severe and steroid-refractory inflammatory bowel disease (15 ulcerative colitis and 8 Crohn's disease) were included. The Mayo Clinic Score and the CDAI were used to evaluate activity. Cyclosporine (4 mg/kg/day) was administered for a maximum of ten and a minimum of 7 days.
Results:
Ten of the 15 ulcerative colitis patients achieved remission with a mean response lag time to onset improvement of 8 days. Seven of these patients remained stable with mesalazine 4 months after cyclosporine treatment. Two patients relapsed and underwent colectomy on the 50th and 200th day after treatment. Five patients presented no response and required urgent colectomy. Six of the 8 Crohn's disease patients achieved remission with a mean response lag time to onset improvement of 7 days. The 6 patients remained stable with mesalazine four months after cyclosporine treatment. The other 2 developed reversible renal failure and had to be released from the study.
Conclusions:
Intravenous high dose cyclosporine is effective and can be used as a rapid onset treatment for acute steroid refractory IBD.