Oral Tacrolimus for Megacolon in Patients with Severe Ulcerative Colitis

Narabayashi, Ken; Inoue, Takuya; Sakanaka, Taisuke; Iguchi, Munetaka; Fujiwara, Kaori; Yorifuji, Naoki; Kakimoto, Kazuki; Nouda, Sadaharu; Okada, Toshihiko; Ishida, Kumi; Abe, Yosuke; Masuda, Daisuke; Takeuchi, Toshihisa; Fukunishi, Shinya; Umegaki, Eiji; Higuchi, Kazuhide

doi:10.2169/internalmedicine.53.2624

Cited by 9 publications

(3 citation statements)

References 13 publications

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“…Based on the results of this study, we believe that starting with oral tacrolimus may be a useful strategy for patients with severe or refractory UC. ( 27 , 28 )…”

Section: Discussionmentioning

confidence: 99%

Cytomegalovirus infection in ulcerative colitis assessed by quantitative polymerase chain reaction: risk factors and effects of immunosuppressants

Henmi

Kakimoto

Inoue

et al. 2018

J. Clin. Biochem. Nutr.

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We investigated the risk factors of and appropriate treatment for cytomegalovirus colitis in patients with ulcerative colitis, using quantitative polymerase chain reaction analysis to detect cytomegalovirus in the colonic mucosa. Between February 2013 and January 2017, patients with exacerbated ulcerative colitis who were admitted to our hospital were consecutively enrolled in this retrospective, single-center study. Patients were evaluated for cytomegalovirus using serology (antigenemia) and quantitative polymerase chain reaction analyses of the colonic mucosa, which were sampled during colonoscopy. Of 86 patients, 26 (30.2%) had positive quantitative polymerase chain reaction results for cytomegalovirus; only 4 were also positive for antigenemia. The ages of the cytomegalovirus DNA-positive patients were significantly higher than those of negative patients (p = 0.002). The mean endoscopic score of cytomegalovirus DNA-positive patients was significantly higher than that of cytomegalovirus DNA-negative patients. Treatment with combined immunosuppressants was associated with an increased risk of cytomegalovirus. Fourteen of 15 (93.3%) cytomegalovirus DNA-positive patients who were negative for antigenemia showed a clinical response to treatment with additional oral tacrolimus, without ganciclovir. cytomegalovirus reactivation in active ulcerative colitis is associated with age and combined immunosuppressant therapy. Because additional treatment with tacrolimus was effective, patients who are negative for antigenemia and cytomegalovirus DNA-positive colonic mucosa may recover without antiviral therapy.

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“…Based on the results of this study, we believe that starting with oral tacrolimus may be a useful strategy for patients with severe or refractory UC. ( 27 , 28 )…”

Section: Discussionmentioning

confidence: 99%

Cytomegalovirus infection in ulcerative colitis assessed by quantitative polymerase chain reaction: risk factors and effects of immunosuppressants

Henmi

Kakimoto

Inoue

et al. 2018

J. Clin. Biochem. Nutr.

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“…In adults, long rectal tube insertion combined with intermittent rolling maneuvers (169) and the knee‐elbow position (170) have been used to promote decompression. Case reports indicate potential effectiveness of infliximab (171–173), leukocytapheresis (174), tacrolimus (175,176), or hyperbaric oxygen (177) for treating toxic megacolon, but the evidence is anecdotal. Although CMV infection is more commonly associated with toxic megacolon, there is not enough evidence to support empiric treatment with ganciclovir without confirmation of CMV infection (178).…”

Section: Initial Managementmentioning

confidence: 99%

Management of Paediatric Ulcerative Colitis, Part 2

Turner

Ruemmele

Orlanski-Meyer

et al. 2018

J. pediatr. gastroenterol. nutr.

192

194

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“…Our results showed that all CMV-DNA-positive patients who were treated with oral tacrolimus without ganciclovir showed clinical responses and decreased numbers of CMV-DNA copies (Figure 3). Because the use of steroids is known to increase the risk of CMV infection, which is associated with disease exacerbation and refractoriness, oral tacrolimus should be used prior to steroid therapy in patients with severe or refractory UC [57].…”

Section: Impact Of Tacrolimus On Cytomegalovirus (Cmv) Colitismentioning

confidence: 99%

Oral Tacrolimus in Patients with Ulcerative Colitis

Inoue¹,

Kakimoto²,

Higuchi³

2016

New Insights Into Inflammatory Bowel Disease

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Tacrolimus is a macrolide immunosuppressant that is structurally similar to rapamycin and has been found to have potent immunosuppressive properties, showing -to -fold higher potency for inhibiting lymphocyte activation than cyclosporine " (Cs" . "ecause less variability in absorption and serum levels is observed among patients treated with tacrolimus compared with those who receive oral Cs", tacrolimus has been suggested to be more easily and safely administered to patients with refractory ulcerative colitis (UC than Cs". However, because oral tacrolimus has a slower onset of action than intravenous Cs" and food intake is known to reduce tacrolimus serum trough levels due to its low absorption rate, the proper method for administration of oral tacrolimus has not been determined. Moreover, the long-term efects of oral tacrolimus also remain unclear. In this chapter, key issues regarding the use of oral tacrolimus in patients with UC are reviewed.

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Oral Tacrolimus for Megacolon in Patients with Severe Ulcerative Colitis

Cited by 9 publications

References 13 publications

Cytomegalovirus infection in ulcerative colitis assessed by quantitative polymerase chain reaction: risk factors and effects of immunosuppressants

Cytomegalovirus infection in ulcerative colitis assessed by quantitative polymerase chain reaction: risk factors and effects of immunosuppressants

Management of Paediatric Ulcerative Colitis, Part 2

Oral Tacrolimus in Patients with Ulcerative Colitis

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