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Approximately 15% of patients with ulcerative colitis will have a severe attack requiring hospitalisation for intravenous steroids at some stage in their illness.1 Sixty per cent of patients treated with corticosteroids will be symptom free by the end of five days, 15% will have significant improvement, and 25% will not improve. Those who fail to improve may be treated with intravenous cyclosporin or undergo colectomy.
EFFICACY OF INTRAVENOUS CYCLOSPORIN IN SEVERE ULCERATIVE COLITIS
There have been four controlled studies of intravenous cyclosporin in patients with severe ulcerative colitis. Of 20 patients reported by Lichtiger et al, nine were randomised to receive placebo and 11 to receive cyclosporin 4 mg/kg/day as a continuous infusion for 14 days.2 Nine of 11 cyclosporin treated patients (82%) responded compared with none of the placebo treated patients. Those who responded were continued on oral cyclosporin 8 mg/kg/day. At six months, 5/11 cyclosporin treated patients (45%) maintained a …