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Cyclosporine as an alternative to surgery in children with inflammatory bowel disease
K J Benkov1, J R Rosh, A H Schwersenz
1Department of Pediatrics, Mount Sinai Hospital and School of Medicine, New York, New York 10029.
Insights
Cyclosporine treatment was ineffective for five pediatric ulcerative colitis patients who ultimately required surgery. This study suggests cyclosporine is not a viable alternative to colectomy in this population.
Area of Science:
- Pediatric Gastroenterology
- Immunosuppressive Therapy
Background:
- Ulcerative colitis (UC) is a chronic inflammatory bowel disease affecting children.
- Corticosteroids are a common treatment, but some patients develop steroid-dependent disease requiring alternative therapies.
- Cyclosporine, an immunosuppressant, has been explored for severe UC.
Observation:
- Five pediatric patients with severe ulcerative colitis, recommended for surgery, received cyclosporine therapy.
- Patients had prior corticosteroid exposure, ranging from 1 to 24 months.
- Treatment involved initial intravenous infusion followed by oral administration to maintain specific trough levels.
Findings:
- One of two acute UC cases failed to respond, necessitating subtotal colectomy.
- The second acute UC case initially responded but later required subtotal colectomy.
- All three chronic, steroid-dependent UC cases underwent subtotal colectomy, with no successful weaning from corticosteroids.
Implications:
- Cyclosporine demonstrated limited efficacy as a surgical alternative in this cohort of pediatric ulcerative colitis patients.
- The role of cyclosporine in managing pediatric ulcerative colitis remains uncertain.
- Further research is needed to determine optimal treatment strategies for severe pediatric ulcerative colitis.
Abstract:
Five children with ulcerative colitis for whom surgery was recommended were treated with cyclosporine. The five had received corticosteroids for 1-24 months. The group included two patients with acute-onset ulcerative colitis and three with acute exacerbations of intractable corticosteroid-dependent chronic ulcerative colitis. The average age at initiation of cyclosporine therapy was 13.8 years (range, 11.5-16); all five patients were boys. Cyclosporine was initiated in the hospital by continuous i.v. infusion. Trough levels of 400-600 ng/dl (measured by radioimmunoassay) were achieved, at which point oral cyclosporine was given and oral dosage was adjusted to similar levels. Significant hypertension requiring medical attention was seen in one patient. Of the two recently diagnosed acute cases, one failed to respond and required subtotal colectomy after 2 weeks of treatment, and the other, despite an initial response, had a subtotal colectomy 10 months later. Of the three corticosteroid-dependent children, none was able to be weaned from corticosteroids and all underwent subtotal colectomy. Our experience emphasizes that the appropriate role of cyclosporine as therapy for children with ulcerative colitis is yet to be determined. Cyclosporine was not effective as an alternative to surgery in our patients.