A novel player: cyclosporine therapy in the management of inflammatory bowel disease

Weissman, Simcha; Chris-Olaiya, Abimbola; Mehta, Tej I; Aziz, Muhammad; Alshati, Ali; Berry, Rani; Fatima, Rawish; Kolli, Sindhura; Hassan, Ammar; Sciarra, Michael

doi:10.21037/tgh.2019.08.08

Cited by 12 publications

(5 citation statements)

References 9 publications

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“…Although CsA has been reported to be associated with serious adverse events, including high blood pressure, nephrotoxicity, and opportunistic infections, 36 there were no serious adverse events associated with CsA treatment in our cohort. Ordas et al .…”

Section: Discussioncontrasting

confidence: 52%

Comparison of outcomes of cyclosporine A and infliximab for steroid‐refractory acute severe ulcerative colitis

Song

Hwang

et al. 2021

J of Gastro and Hepatol

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Background and Aim Data comparing the outcomes of cyclosporin A (CsA) and infliximab (IFX) as rescue therapy for steroid‐refractory acute severe ulcerative colitis (SR‐ASUC) among Asians are scarce. Methods In this single‐center study, we retrospectively reviewed 121 patients with SR‐ASUC according to the Truelove and Witts' criteria who received CsA or IFX as rescue therapy between 1995 and 2015. The cumulative rates of treatment failure and colectomy at 3 months were compared. Treatment failure was defined as colectomy, switch to other medications, acute flare‐up events requiring steroid treatment, or adverse events leading to drug interruption. Results Among 121 patients with SR‐ASUC (male, 55.6%; median disease duration, 47.1 months; extensive colitis, 61.2%), 23 received CsA as rescue therapy. Baseline characteristics (e.g. age at diagnosis, sex, disease duration, disease extent at rescue therapy, and Mayo score at treatment initiation) were comparable between the two groups. During follow‐up (median, 45 months; interquartile range 29.3–61.8), 84 patients (69.4%) experienced treatment failure, and 25 patients (20.7%) underwent colectomy. The CsA group and the IFX group did not show significant differences in the cumulative rates of treatment failure (39.1% vs 34.7%, P = 0.714) and colectomy (26.1% vs 13.3%, P = 0.198) at 3 months. Previous use of azathioprine (odds ratio [OR] = 2.309, 95% confidence interval [CI] = 1.076–4.951, P = 0.032) was associated with treatment failure at 3 months. Mayo score > 10 at the time of rescue therapy was significantly associated with colectomy at 3 months (OR = 8.444, 95% CI = 2.592–27.506, P < 0.001). Conclusion Among Korean patients with SR‐ASUC, the rates of treatment failure and colectomy at 3 months were not significantly different between the CSA and the IFX treatment groups.

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Section: Discussioncontrasting

confidence: 52%

Comparison of outcomes of cyclosporine A and infliximab for steroid‐refractory acute severe ulcerative colitis

Song

Hwang

et al. 2021

J of Gastro and Hepatol

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“…This in turn inhibits the production of multiple cytokines including interleukin (IL)-2, IL-3, IL-4, tumor necrosis factor (TNF)-α, interferon-gamma and granulocyte-macrophage colony-stimulating factor, thereby inhibiting T-cell proliferation and differentiation. 13…”

Section: Cyclosporinmentioning

confidence: 99%

What to do when traditional rescue therapies fail in acute severe ulcerative colitis

Li Wai Suen,

Choy,

De Cruz

2024

Intest Res

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fractory ASUC may be improved with novel infliximab dosing strategies, use of cyclosporin as a bridge to slower acting biologic agents and Janus kinase (JAK) inhibitors as sequential therapy. [8][9][10][11] In this review, we provide an overview of the traditional rescue therapies available in ASUC and mechanisms of failure of rescue therapies. We then summarize and synthesize the emerging literature on contemporary approaches to clinical management of ASUC in the setting of failure to respond to traditional rescue therapies. SEARCH STRATEGYReferences for this review were identified through electronic searches of Ovid Medline and EMBASE (inception to December 2023), and conference proceedings identified using EM-BASE (January 2020 to December 2023). The following search terms were used alone or in combination: "acute severe colitis, " "ASUC, " "ulcerative colitis, " "hospital, " "severe, " "infliximab, " "cyclosporin, " "ciclosporin, " "tofacitinib, " "upadacitinib, " "vedolizumab", or "ustekinumab. " Only papers published in English were reviewed. The final reference list was generated based on originality and relevance to the scope of this review.

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“…It provided an avenue for "salvage therapy" in otherwise steroid-refractory IBD patients. 10 As a result, many patients may be on cyclosporine when the need for urgent or emergent surgical intervention arises. In small studies, cyclosporine does not appear to have adverse effects on postoperative recovery, although there is a risk of renal injury and opportunistic infections.…”

Section: Cyclosporinementioning

confidence: 99%

Perioperative Assessment and Optimization in Major Colorectal Surgery: Medication Management

Kane

Berry

2023

Clin Colon Rectal Surg

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The colorectal surgeon is often faced with medications that can be challenging to manage in the perioperative period. In the era of novel agents for anticoagulation and immunotherapies for inflammatory bowel disease and malignancy, understanding how to advise patients about these medications has become increasingly complex. Here, we aim to provide clarity regarding the use of these agents and their perioperative management, with a particular focus on when to stop and restart them perioperatively. This review will begin with the management of both nonbiologic and biologic therapies used in the treatment of inflammatory bowel disease and malignancy. Then, discussion will shift to anticoagulant and antiplatelet medications, including their associated reversal agents. Upon finishing this review, the reader will have gained an increased familiarity with the management of common medications requiring modification by colorectal surgeons in the perioperative period.

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A novel player: cyclosporine therapy in the management of inflammatory bowel disease

Cited by 12 publications

References 9 publications

Comparison of outcomes of cyclosporine A and infliximab for steroid‐refractory acute severe ulcerative colitis

Comparison of outcomes of cyclosporine A and infliximab for steroid‐refractory acute severe ulcerative colitis

What to do when traditional rescue therapies fail in acute severe ulcerative colitis

Perioperative Assessment and Optimization in Major Colorectal Surgery: Medication Management

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