Is cyclosporine as effective in chronic ul cerative colitis as in severe ulcerative colitis?

Is There Still a Role for Cyclosporine in the Treatment of Inflammatory Bowel Disease? Pro Argument

“…An additional six open‐label series with a total of 344 patients have demonstrated consistent response rates of 56% to 84% for the acute intravenous phase, with a mean response rate of 75% (Table 1) (5–10). Importantly, in the series with the lowest response rate of 56% (5), patients were treated with intravenous CSA for only 4.5 days and achieved a mean serum CSA level of only 100 to 200 ng/mL, compared with 9 days of treatment and a mean CSA level of 432 ng/mL in the RCT of Lichtiger et al (1).…”

“…Certainly, absorbing the risks of CSA would hardly be worth the effort if we could not successfully taper steroids and CSA after hospital discharge and maintain remission for more than just the short term. Fortunately, remission can be achieved and maintained in 55% to 69% of patients for up to 5.5 years (8–10) if 6‐mercaptopurine (6‐MP) or azathioprine is added soon after hospital discharge (Table 2). In patients in whom long‐term 6‐MP or azathioprine is not added, the abysmal long‐term response rate is as low as 19% (8).…”

“…Fortunately, remission can be achieved and maintained in 55% to 69% of patients for up to 5.5 years (8–10) if 6‐mercaptopurine (6‐MP) or azathioprine is added soon after hospital discharge (Table 2). In patients in whom long‐term 6‐MP or azathioprine is not added, the abysmal long‐term response rate is as low as 19% (8). Therefore, CSA should only be viewed as “rescue” or “bridge” therapy in UC while allowing the slower‐acting 6‐MP or azathioprine to take effect.…”