Skip to main content

Advertisement

Log in

Cyclosporine in inflammatory bowel disease

  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

For the past decade, the use of oral and intravenous cyclospo rine has been examined for patients with inflammatory bowe disease who have demonstrated resistance to steroid treatment. Updated and new results from a number of studies offer short-term and long-term data on cyclosporine and its effectiveness in achieving and maintaining remission from disease. Short-term and long-term toxicity associated with cyclosporine is reviewed here, as well as quality of life among patients who have been treated successfully. Also discussed are practice patterns among clinicians using cyclosporine in its varied formulations and the appropriate settings for its use

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Lichtiger S, Present DH: Preliminary report: cyclosporine in treatment of severe active ulcerative colitis. Lancet 1990, 336:16–19.

    Article  PubMed  CAS  Google Scholar 

  2. Sandborn WJ: A critical review of cyclosporine therapy in inflammatory bowel disease. Inflamm Bowel Dis 1995, 1:48–63. Another superb Sandborn review. Meticulously detailed and authoritative review of all open-label and controlled CSA data in IBD. Although 4 years have passed since its publication, it is still timely and relevant.

    Article  Google Scholar 

  3. Yoon C, Kornbluth A., George J, et al.: Is cyclosporine as effective in chronic ulcerative colitis as in severe ulcerativ colitis? Gastroenterology 1998, 114:G4586. Largest series of UC patients treated with CSA to date demonstrating equivalent short- and long-term response rates in different patient subsets. 6-MP is essential for long-term maintenance of remission.

    Google Scholar 

  4. Cohen RD, Stein R, Hanauer SB: Intravenous cyclosporine in ulcerative colitis: A five-year experience. Am J Gastroenterol 1999, 94:1587–1592.

    Article  PubMed  CAS  Google Scholar 

  5. Actis GC, Aimo G, Priolo G, et al.: Efficacy and efficiency o oral microemulsion cyclosporine versus intravenous and soft gelatin capsule cyclosporine in the treatment of severe steroid-refractory ulcerative colitis: an open-label retrospective trial. Inflamm Bowel Dis 1998, 4:276–279. An important variation on standard oral CSA use. Fifteen patients with milder disease avoided the IV CSA phase with use of Neoral.

    Article  PubMed  CAS  Google Scholar 

  6. Actis GC, Ottobrelli A, Pera A, et al.: 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. J Clin Gastroenterol 1993, 17:10–13.

    Article  PubMed  CAS  Google Scholar 

  7. Kozarik JM, Mueller EA, Johnston A, et al.: Bioequivalence of soft gelatin capsules and oral solution of a new cyclosporine formulation. Pharmacotherapy 1993, 13:613–617.

    Google Scholar 

  8. Andreoli A., Falasco G., Mangiarotti R., et al.: Efficacy of lon term oral-6-mercapopurine therapy in maintaining remission induced by intravenous cyclosporine in steroid-refractory severe ulcerative colitis. Gastroenterology 1999, 116:G2883.

    Google Scholar 

  9. D'Haens G, Lemmens L, Hiele M, et al.: Remission of severe ulcerative colitis with cyclosporine monotherapy is effectively maintained with further immunosuppression. Gastroenterology 1999, 118:G2984.

    Google Scholar 

  10. Hyde GM, Thillainayagan AV, Jewell DP: Intravenous cyclosporine and rescue therapy in severe ulcerative colitis: time for a reappraisal? Eur J Gastroenterol Hepatol 1998, 10:411–413. The key finding in this reported study is of lower acute success rates with a shorter course of IV CSA and lower long-term success rates when AZA/6-MP is not added.

    Article  PubMed  CAS  Google Scholar 

  11. Lichtiger S, Present DH, Kornbluth A, et al.: Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl Med 1994, 330:1841–1845.

    Article  CAS  Google Scholar 

  12. Kornbluth A, Lichtiger S, Present DH, et al.: Long term results of oral cyclosporine in patients with severe ulcerative colitis: a double-blind, randomized, multi-center trial [abstract]. Gastroenterology 1994, 106:A714.

    Google Scholar 

  13. Sternthal M, George J, Kornbluth A, et al.: Toxicity associated with the use of cyclosporine in patients with inflammatory bowel disease [abstract]. Gastroenterology 1996, 110:A1019.

    Google Scholar 

  14. Mahadevan U, Kornbluth A, Goldstein E, et al.: Is cyclosporine induced nephrotoxicity permanent or progressive in patients with inflammatory bowel disease? Gastroenterology 1997, 112:A1030.

    Google Scholar 

  15. D'Haens G, Lemmens L, Aerden I, et al.: Cyclosporine therapy for ulcerative colitis does not cause permanent renal damage. Gastroenterology 1999, 118:G2329.

    Google Scholar 

  16. Feutren G, Mihatsch MJ, for The International Kidney Biopsy Registry of Cyclosporine in Autoimmune Diseases: Risk factors for cyclosporine-induced nephropathy in patients with autoimmune diseases. N Engl J Med 1992, 326:1654–1660.

    Article  PubMed  CAS  Google Scholar 

  17. Kornbluth A, Present DH, Lichtiger S, Hanauer S: Cyclosporine for severe ulcerative colitis: a user's guide. Am J Gastroenterol 1997, 92:1424–1428. A practical “how-to” guide from the Mount Sinai/University of Chicago intravenous and oral CSA protocol.

    PubMed  CAS  Google Scholar 

  18. D'Haens G, Shenaert P, Westhorens R, Rutgeerts P: Severe knee pain as a single symptom of cytomegalovirus infection in acute ulcerative colitis treated with cyclosporine. Inflamm Bowel Dis 1998, 4:27–28.

    Article  PubMed  Google Scholar 

  19. Isaacs K: Severe bone pain as an adverse effect of cyclosporine therapy for Crohn's disease. Inflamm Bowel Di 1998, 4:95–97.

    Article  CAS  Google Scholar 

  20. Vega R, Bertran X, Menacho M, et al.: Cytomegalovirus i nfection in patients with inflammatory bowel disease. Am J Gastroenterol 1999, 94:1053–1056.

    Article  PubMed  CAS  Google Scholar 

  21. Schneider JH, Sternthal MB, Lichtiger S, et al.: Cyclosporine therapy in patients with severe ulcerative colitis: a quality of life assessment [abstract]. Am J Gastroenterol 1991, 86:A1361.

    Google Scholar 

  22. Khagan N, Sternthal M, Weiss A: Health related quality of life in patients treated with cyclosporine for severe ulcerative colitis: a comparison between patients with and without colectomy [abstract]. Gastroenterology 1997, 112:A1012.

    Google Scholar 

  23. Cohen RD, Brodsky AL, Hanauer SB: A comparison of the quality of life in patients with severe ulcerative colitis after total colectomy versus medical treatment with intravenous cyclosporine. Inflamm Bowel Dis 1999, 5:1–10. A detailed study demonstrating improved daily quality of life in successfully treated CSA patients compared with patients cured with surgery.

    Article  PubMed  CAS  Google Scholar 

  24. Kozarek R, Bedard C, Patterson D, et al.: Cyclosporine use in the pre-colectomy chronic ulcerative colitis patient: A community experience and its relationship to prospective and controlled clinical trials. Am J Gastroenterol 1995, 90:2093–2096.

    PubMed  CAS  Google Scholar 

  25. Stack WA, Williams D, Stevenson M, Logan RS: Immunosuppressive therapy for ulcerative colitis: results of a nationwide survey among consultant physician members of the British Society of Gastroenterology. Aliment Pharmacol Ther1999, 13 569–575.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kornbluth, A. Cyclosporine in inflammatory bowel disease. Curr Gastroenterol Rep 1, 486–490 (1999). https://doi.org/10.1007/s11894-999-0008-4

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-999-0008-4

Keywords

Navigation