Table 1

Clinical response to topical tacrolimus in eight patients

Patient NoAge (y); SexSite of diseasePrevious unsuccessful therapyResponse to topical tacrolimus (0.5 mg/g twice daily)Effects of dosage reduction/stopping treatment
113; FHDPDOS, TS, EN, ASA, TCya, Met, Cip.Rapid granulation of cavity edges. Initial healing by 6 months.Partial breakdown when dose reduced. Subsequently healed after returned to full dosage. Later able to tolerate dose reduction.
28; FExtensive perineal ulcerationOS, TS, EN, ASA, TCya, Aza, Met, Cip. Past response to OCyaRapid response, with healing in 5 weeks.Marked relapse when treatment stopped. Subsequently less good response. Eventual requirement for proctectomy.
35; MOral Crohn's, later HDPDOS, TS, exclusion diets, MetMarked resolution of lip swelling in 4 weeks. Subsequent rapid resolution of perianal ulceration.No relapse as dosage reduced. Now on intermittent dosage as required.
414; MPerianal ulceration with distal proctitisOS, TS, ASA, Met, Cip, AZAResolution of perianal disease within 8 weeks. Distal proctitis unchanged.No relapse as dosage reduced. Now off therapy.
511; FHDPD with severe colitisOS, TS, AZA, TCya, OCya, Met, CipUsed with oral tacrolimus. Improvement in pain, but no remission.Worsening whenever dose reduced. Subsequent moderate improvement with anti-TNF monoclonal.
618; MOral Crohn's with severe lip swellingOS, TS, ASA, EN, exclusion diets, AZA, MetRapid reduction in lip swelling. Able to wean from high dose steroids.Able to reduce to once daily dose without recurrence.
79; MPerianal ulceration and fistulaOS, ASA, Met, CipRapid response in 4 weeks, with healing of deep fissure.Remains well on reduced dosage.
810; MSevere lip swellingEN, ASALips normal at 6 weeks.No immediate problems after weaning, but relapsed at 6/12—again responded to tacrolimus.
  • HDPD, highly destructive perianal disease; OS, oral steroids; TS, topical steroids; ASA, aminosalicylates; OCya, oral cyclosporin; TCya, topical cyclosporin; Met, metronidazole; Cip, ciprofloxacin; AZA, azathioprine; EN, enteral nutrition.