Ciclosporin ulcerative colitis

Several studies have been conducted, including some small randomised studies, to assess the use of ciclosporin in Crohn s disease. The evidence suggests that intravenous ciclosporin can induce disease remission in severe flares of ulcerative colitis that are unresponsive to corticosteroids. Oral ciclosporin has only been shown to be useful as a bridging treatment between intravenous ciclosporin and more long-term maintenance strategies. 

Severe attacks of ulcerative colitis should be treated in hospital with intravenous corticosteroid. The main danger is toxic dilatation of the colon and perforation, which can occur insidiously. Regular measurements of abdominal girth and straight x-ray of the abdomen are useful in monitoring response, which should be seen within 72 h. If there is no improvement a trial of ciclosporin (see below) may induce response. Treatment otherwise is by emergency colectomy. 

Ciclosporin may induce remission in some patients with severe ulcerative colitis unresponsive to corticosteroid. The drug is given in a dose of 2-4 mg/kg i.v. until remission is attained. Renal function should be monitored closely as ciclosporin is nephrotoxic (see p. 620). For maintenance therapy azathioprine (see below) is often substituted. Ciclosporin use only delays surgery for many patients after 1 year 50% will have relapsed and undergone colectomy. 

In a 51-year-old woman with a renal transplant who had been stable for the past 13.5 months with ciclosporin (9.6 mg/kg) and sulfasalazine (1.5 g/day) for ulcerative colitis, sulfasalazine withdrawal resulted in an almost two-fold increase in ciclosporin blood concentrations over the next 10 days (294). 

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See also in sourсe #XX -- [ , ]

See also in sourсe #XX -- [ ]

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