High-dose intravenous cyclosporine in steroid refractory attacks of inflammatory bowel disease

Hepatogastroenterology. Jul-Aug 1999;46(28):2265-8.

Abstract

Background/aims: To determin whether cyclosporine is effective in inducing remission in patients with severe active inflammatory bowel disease, refractory to steroids.

Methodology: Twenty-three patients with severe and steroid-refractory inflammatory bowel disease (15 ulcerative colitis and 8 Crohn's disease) were included. The Mayo Clinic Score and the CDAI were used to evaluate activity. Cyclosporine (4 mg/kg/day) was administered for a maximum of ten and a minimum of 7 days.

Results: Ten of the 15 ulcerative colitis patients achieved remission with a mean response lag time to onset improvement of 8 days. Seven of these patients remained stable with mesalazine 4 months after cyclosporine treatment. Two patients relapsed and underwent colectomy on the 50th and 200th day after treatment. Five patients presented no response and required urgent colectomy. Six of the 8 Crohn's disease patients achieved remission with a mean response lag time to onset improvement of 7 days. The 6 patients remained stable with mesalazine four months after cyclosporine treatment. The other 2 developed reversible renal failure and had to be released from the study.

Conclusions: Intravenous high dose cyclosporine is effective and can be used as a rapid onset treatment for acute steroid refractory IBD.

Publication types

  • Clinical Trial

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Colitis, Ulcerative / drug therapy*
  • Colitis, Ulcerative / surgery
  • Crohn Disease / drug therapy*
  • Crohn Disease / surgery
  • Cyclosporine / administration & dosage*
  • Cyclosporine / adverse effects
  • Drug Resistance
  • Female
  • Glucocorticoids / therapeutic use
  • Humans
  • Immunosuppressive Agents / administration & dosage*
  • Immunosuppressive Agents / adverse effects
  • Injections, Intravenous
  • Male
  • Mesalamine / therapeutic use
  • Middle Aged
  • Prospective Studies
  • Remission Induction

Substances

  • Anti-Inflammatory Agents, Non-Steroidal
  • Glucocorticoids
  • Immunosuppressive Agents
  • Mesalamine
  • Cyclosporine