Ciclosporin for severe refractory colitis

Intravenous ciclosporin is a promising alternative, rapidly effective, for patients with severe steroid-refractory colitis previously facing only surgical options, however its use is controversial because of the frequency of adverse effects and the doubt about the long-term response.

This review will provide information on clinical pharmacology, clinical indications for use, methods of dose adjustment, monitoring of metabolites for efficacy and for potential side effects and the adverse event profile of ciclosporin in severe refractory colitis.

Literature review.

Toxicity is dominated by opportunistic infections. Renal and neurotoxicity are also recognized. Risks of toxicity can be reduced by using lower doses, by oral microemulsion or by monotherapy without corticosteroids. The drug should not be continued for more than 3 to 6 months. As a bridge to other maintenance therapy such as azathioprine or 6-mercaptopurine ciclosporin can be an effective treatment.

CSA is a viable alternative to emergency colectomy in severe UC in the short term. Although these benefits are not maintained in all patients, more than a half will also avoid colectomy in the longer term. Careful selection and monitoring of patients, use of lower doses, and oral therapy will help to reduce side effects.