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Updated: Feb 12, 2026
Quantification of the Immunosuppressant Tacrolimus on Dried Blood Spots Using LC-MS/MS
Published on: November 8, 2015
Tacrolimus therapy in moderate to subacute ulcerative proctocolitis: a large single-centre cohort study
Aamir Saifuddin1, Adam Harris1
1Department of Gastroenterology, Tunbridge Wells Hospital, Maidstone and Tunbridge Wells NHS Trust, Kent, UK.
Objective:
To explore the 'real world' effectiveness of tacrolimus therapy for refractory ulcerative proctocolitis (UC).
Design:
Retrospective cohort study using prospectively collated clinical data.
Setting:
A single district general hospital in Kent, UK. Clinical decisions and regular monitoring were undertaken by a single expert in inflammatory bowel disease.
Patients:
All patients started on tacrolimus between January 2010 and August 2016 at Tunbridge Wells Hospital.
Interventions:
Following failure of conventional medication, tacrolimus was commenced at 0.5 mg/kg twice daily. Drug trough levels of 5-20 ng/mL were targeted. Other immunomodulation was stopped and steroids were weaned over 4-6 weeks.
Main Outcome Measures:
Treatment duration was measured for each patient. If the drug was stopped, the rationale, including specific side effects, was recorded. The patient's subsequent management plan was noted.
Results:
Thirty-five patients were started on tacrolimus (range: 18-85, median: 36 years). Disease extent included proctitis to pancolitis. Twenty-five patients derived no benefit. Four patients responded, but drug side effects necessitated withdrawal. Eighteen of these 29 patients (62%) underwent surgery. One patient, who had previously responded, stopped the drug after becoming pregnant (healthy subsequent birth). Therefore, 5 of 35 patients (14%) remain on tacrolimus with sustained clinical response, ranging from 6 to 76 (median: 32) months of treatment. Treatment was most effective for proctosigmoiditis. There were no other demographic or biological markers for success.
Conclusions:
In line with UK and European guidelines, tacrolimus can be beneficial for refractory UC. With appropriate monitoring, it appears treatment can be continued safely long term.
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