Introduction Ciclosporin (CsA) has been shown to be effective in treatment of steroid refractory severe ulcerative colitis and reducing the need for colectomy1. Most published evidence concerns intravenous infusions; however oral microemulsion ciclosporin (Neoral®) is well absorbed, more convenient and potentially less toxic. We report our experience with oral ciclosporin for treatment of steroid refractory severe ulcerative colitis.
Methods 30 consecutive patients receiving oral Ciclosporin for steroid refractory acute severe ulcerative colitis from October 2001 till July 2012 were retrieved from our clinical and pathology database. One patient received therapy twice. Hence, 31 episodes were analysed for this study.
Results 19/31 patients were males. The median age at diagnosis and at the time of starting CsA was 39 years and 42 years respectively. 19 patients had pancolitis and 11 patients had left sided colitis. 4 patients were not on any treatment at the time of acute flare up. 28 patients were treated as inpatients. CsA was started after a median of 5 days after treatment with intravenous hydrocortisone in admitted patients (range 2–13 days). The mean CsA dose was 7.31 mg/kg on admission (range 5 to 8). The mean ciclosporin trough levels at 48–72hours and days 5–7 were 167ng/ml and 254ng/ml respectively. The mean length of treatment was 23.6 weeks (range 1–123). 50% had no side effects. One patient developed pyrexia of unknown origin necessitating stoppage of CsA. 26/31 (84%) had initial clinical response. 5/31 had colectomies during the same admission while 15/31 (48%) had colectomies within one year of starting ciclosporin treatment. 14/31 (46%) have had no surgery till date after a mean follow up of 46 months (range 2–131). 14/26 who had initial response to CsA were started on azathioprine. Eleven were thiopurine naïve and out of these, 8/11 (72%) are colectomy free till date. 12/26 were on thiopurines in the past. Only 4 of these 12 patients (33%) are colectomy free till date.
Conclusion 84% of the cohort of patients having steroid refractory severe ulcerative colitis responded to CsA and 52% retained their colon after 1 year. Our experience confirms CsA to be a safe drug with few side effects and should be used as a bridging therapy to azathioprine. Patients who are azathioprine naïve prior to CsA appear to have lower colectomy rates.
Disclosure of Interest None Declared.
Campbell S, Travis S, Jewell D. Ciclosporin use in acute ulcerative colitis: a long term experience. Eur J Gastroenterol Hepatol 2005 Jan; 17(1):79–84
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