COMMENTARY
Ulcerative colitis
Tacrolimus—finally!
Robert-Bosch-Hospital, Department of Gastroenterology, Hepatology, and Endocrinology, Stuttgart, Germany
Correspondence to:
Correspondence to:
Dr K Herrlinger
Department of Gastroenterology, Hepatology, and Endocrinology, Robert-Bosch-Hospital, Auerbachstrasse 110, D-70376 Stuttgart; klaus.herrlinger@rbk.de
Tacrolimus appears to be at least comparable to ciclosporin in refractory ulcerative colitis in terms of tolerability and efficacy but the oral route of administration and reliability of drug levels are advantageous
Keywords: ulcerative colitis, immunosuppressive therapy, tacrolimus
| The first 150 words of the full text of this article appear below. |
Tacrolimus is a new calcineurin inhibitor widely used in transplantation medicine. Similar to ciclosporin, tacrolimus inhibits the calmodulin sensitive serine phosphatase calcineurin, thereby reducing NF-AT activation. In this issue of Gut, Ogata and colleagues1 present the first randomised controlled trial of tacrolimus in patients with "refractory" ulcerative colitis (see page 1255). Two tacrolimus arms with low and high trough levels were compared with a placebo group. Oral dosing was adjusted to trough levels by an external board to secure blinding. The primary end point was the proportion of patients with improvement after two weeks based on a disease activity index (DAI) score, a composite of clinical and endoscopic findings, with a range of 0–12 points. Sixty patients were included in the efficacy analysis, of whom only 15 had been "steroid resistant". Improvement (decrease in DAI score by 
4) was achieved in 68%, 38%, and 10%
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Gut 2006 55: 1255-1262.[Abstract] [Full Text] [PDF]
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