Cyclosporine in steroid refractory acute severe colitis

Tropical Gastroenterology : Official Journal of the Digestive Diseases Foundation
N Suraj KumarGovind K Makharia

Abstract

Approximately 15-20% patients with ulcerative colitis (UC) suffer from a severe flare during their lifetime which required hospitalization. Intravenous corticosteroids are the first line of therapy for acute severe UC. While almost 70-80% of patients respond to corticosteroids 20% do not. Although colectomy for UC is curative, it has its problems such as increased frequency of stool and pouchitis, which led to search for colon rescue therapy. Cyclosporine and anti-tumor necrosis factor-alpha (anti-TNF á) have emerged as effective colon rescue therapy. While the short-term efficacy of cyclosporine in preventing colectomy is 64-86%, the long-term efficacy is not as good and almost 70% eventually require colectomy over 1-7 years. The efficacy of cyclosporine is equivalent both at a high and low doses and cyclosporine is now used most often as a low dose regime in patients with steroid refractory acute severe UC. Furthermore, recent data suggest that the both cyclosporine and infliximab are equally effective in steroid refractory acute severe UC. Monitoring patients for adverse events and serum cyclosporine levels is mandatory. The response to both cyclosporine and infliximab is rapid and usually occurs within 4-5 days. Despite mou...Continue Reading

Citations

Mar 23, 2019·Paediatrics and International Child Health·Anthony Mark Dalzell, Muhammad Eyad Ba'Ath
Apr 14, 2019·Inflammatory Bowel Diseases·Biyu WuZhihua Ran
Jun 11, 2020·Journal of Clinical Medicine·Keiichi HagaAkihito Nagahara

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