Journal of Gastroenterology

, Volume 45, Issue 11, pp 1129–1137

Rapid endoscopic improvement is important for 1-year avoidance of colectomy but not for the long-term prognosis in cyclosporine A treatment for ulcerative colitis

  • Taku Kobayashi
  • Makoto Naganuma
  • Susumu Okamoto
  • Tadakazu Hisamatsu
  • Nagamu Inoue
  • Hitoshi Ichikawa
  • Tetsuro Takayama
  • Riko Saito
  • Tomohisa Sujino
  • Haruhiko Ogata
  • Yasushi Iwao
  • Toshifumi Hibi
Original Article—Alimentary Tract

Abstract

Background

Intravenous (IV) cyclosporine A (CSA) is one of the treatments of choice for patients with steroid-refractory severe ulcerative colitis (UC). In this study, we evaluated the overall experience with CSA treatment in UC patients, from their initial response to long-term prognosis.

Methods

The medical records of 72 patients admitted to our hospital with a severe UC flare-up and treated with IV CSA between November 1996 and October 2008 were reviewed retrospectively. The initial response to CSA was assessed using a clinical activity index, and colectomy was assigned as the endpoint for the long-term prognosis.

Results

Overall, 53 of 72 (73.6%) patients responded initially to CSA. We could not determine any specific parameters that predicted an initial response. A life-table analysis for all patients revealed that 54.4% of patients required a colectomy within 11 years. The long-term risk of surgery was associated with a shorter disease duration, history of adverse reactions against medications and lack of immunomodulator use. In addition, endoscopic improvement at day 14 was associated with colectomy at 1 year, but not with the long-term prognosis.

Conclusions

Although CSA can exert high initial efficacy for severe attacks of UC, >50% of patients who relapse require a colectomy. Specifically, mucosal healing evaluated by endoscopy was associated with the 1-year colectomy rate. In contrast, a history of adverse drug reactions was correlated with the long-term colectomy rate. Therefore, we propose that treatment of severe UC with CSA requires consideration of both initial remission and long-term maintenance as management goals.

Keywords

Ulcerative colitis Cyclosporine A 6-Mercaptopurine Azathioprine 

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Copyright information

© Springer 2010

Authors and Affiliations

  • Taku Kobayashi
    • 1
  • Makoto Naganuma
    • 1
  • Susumu Okamoto
    • 1
  • Tadakazu Hisamatsu
    • 1
  • Nagamu Inoue
    • 2
  • Hitoshi Ichikawa
    • 1
  • Tetsuro Takayama
    • 1
  • Riko Saito
    • 1
  • Tomohisa Sujino
    • 1
  • Haruhiko Ogata
    • 2
  • Yasushi Iwao
    • 2
  • Toshifumi Hibi
    • 1
  1. 1.Division of Gastroenterology and Hepatology, Department of Internal MedicineKeio University School of MedicineTokyoJapan
  2. 2.Center for Diagnostic and Therapeutic EndoscopyKeio University HospitalTokyoJapan

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