Continuously Infused Cyclosporine at Low Dose Is Sufficient to Avoid Emergency Colectomy in Acute Attacks of Ulcerative Colitis Without the Need for High-Dose Steroids

Actis, Giovanni C; Ottobrelli, A.; Pera, A.; Barletti, C.; Ponti, V.; Pinna-Pintor, M; Verme, G

doi:10.1097/00004836-199307000-00004

Cited by 73 publications

(30 citation statements)

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“…With respect to steroid-refractory or steroid-dependent UC, CSA induction therapy provides an effective medical alternative for patients previously faced with only surgical options. Uncontrolled trials (1,2) and controlled trials (3) established the efficacy of short-term CSA use as a 'rescue therapy' in severe UC. Lichtiger et al reported that intravenous CSA followed by oral therapy demonstrated an initial response rate of 82% within a mean of 7 days versus 0% in the group that received steroids alone (3).…”

Section: Introductionmentioning

confidence: 99%

Prognostic factors for colectomy in refractory ulcerative colitis treated with calcineurin inhibitors

Bamba

Andoh

Imaeda

et al. 2012

Experimental and Therapeutic Medicine

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Abstract. Calcineurin inhibitors (CNIs) such as cyclosporin A (CSA) and tacrolimus (FK506) are efficacious in patients with steroid-refractory or steroid-dependent ulcerative colitis (UC). We retrospectively investigated patients with refractory UC treated with CNIs to elucidate the prognostic factors for a colectomy. Data from 59 patients (35 men and 24 women) were analyzed. CSA and FK506 were administered by intravenous infusion and peroral administration, respectively. The efficacy of the CNIs was assessed using Seo's complex integrated disease activity index. Categorical data analyses were also conducted. The results revealed that the response rates for CSA and FK506 were similar (CSA, 66.6%; FK506, 63.6%). However, oral FK506 had a slower onset of action than intravenous CSA. The risk factors for CNI non-responsiveness were: i) more than 10,000 mg of prednisolone used prior to CNI treatment; and ii) positivity for cytomegalovirus antigenemia (C7-HRP). The factors affecting the rate of colectomy were: i) CNI non-responsiveness; ii) more than 10,000 mg of prednisolone used prior to the initiation of CNI treatment; and iii) positivity for C7-HRP. The addition of azathioprine (AZA) following CNI treatment significantly reduced the incidence of colectomy. Our results revealed the prognostic factors affecting the efficacy of CNI therapy and the need for colectomy in patients with refractory UC. Importantly, some of these factors may be obtained prior to or shortly following the start of CNI treatment. Furthermore, AZA is an important agent for averting colectomy once a patient responds to CNIs.

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Section: Introductionmentioning

confidence: 99%

Prognostic factors for colectomy in refractory ulcerative colitis treated with calcineurin inhibitors

Bamba

Andoh

Imaeda

et al. 2012

Experimental and Therapeutic Medicine

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“…Cyclosporine A Promising results from uncontrolled trials [27,28] were substantiated by a two-center, randomized, placebo-controlled trial from North America in which intravenous cyclosporine at a dose of 4 mg/kg was given to UC patients not responding to intravenous steroids. An ini- Table 2.…”

Section: Steroidsmentioning

confidence: 99%

Treatment of Severe Ulcerative Colitis: Differences in Elderly Patients?

Vavricka

Rogler

2009

Dig Dis

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Almost as many as 10% of patients with ulcerative colitis have late onset with the first flare occurring at 60–70 years of age. The course of the disease and the basic principles of management in geriatric populations do not differ from those in younger patients. However, elderly patients pose distinct problems in therapy choice. In middle-aged patients untreated severe ulcerative colitis has been reduced to <1% in specialized centers at the present time but is still high in the elderly. In general, the management requires close collaboration between gastroenterologists and surgeons. In adult patients, current evidence supports initial treatment with intravenous steroids. However, only 40% of patients show complete response after corticosteroid therapy and almost 30% come to colectomy. Cyclosporine still has a first place as salvage therapy because of its short half-life and its established short-term efficacy in about 70% of patients who fail steroids. The drug should be avoided in frail or elderly patients (especially over 80 years old) with significant comorbidity, and also where colectomy is likely to be necessary in the short to medium term. The long-term benefit of this therapy remains unsatisfactory as colectomy is often only delayed. Infliximab is the choice for those patients with a less severe colitis and less likelihood of urgent colectomy. Tacrolimus has only been used in one randomized controlled trial with similar results to cyclosporine. Surgery is still the definitive procedure for the treatment of ulcerative colitis in adult patients, and its timing is of paramount importance.

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“…Of those, the mean CAI score for the LRT group (8; range, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] was significantly greater than that for the without LRT group (7.5; range, 2-16). We found infectious complications in 6 (13.0%) of 46 patients in the LRT group and 10 (6.8%) of 147 in the without LRT group, a difference that was not significant.…”

Section: Postoperative Complicationsmentioning

confidence: 99%

Leukocyte removal therapy for ulcerative colitis does not affect postoperative complications

et al. 2006

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Continuously Infused Cyclosporine at Low Dose Is Sufficient to Avoid Emergency Colectomy in Acute Attacks of Ulcerative Colitis Without the Need for High-Dose Steroids

Cited by 73 publications

References 0 publications

Prognostic factors for colectomy in refractory ulcerative colitis treated with calcineurin inhibitors

Prognostic factors for colectomy in refractory ulcerative colitis treated with calcineurin inhibitors

Treatment of Severe Ulcerative Colitis: Differences in Elderly Patients?

Leukocyte removal therapy for ulcerative colitis does not affect postoperative complications

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