| Theme | Role of AZA/6-MP in the Treatment of Inflammatory Bowel Disease | |
|---|---|---|
| Title | Comparative Effect of Other Treatments with AZA/6-MP in the Steroid Dependent / Resistant Inflammatory Bowel Disease -- Cyclosporin | |
| Publish Date | 2007/11 | |
| Author | Naoki Yoshimura | Department of Internal Medicine, Social Insurance Chuo General Hospital |
| Author | Yasuo Suzuki | Internal Medicine, Sakura Medicol center Toho University |
| Author | Masakazu Takazoe | Department of Internal Medicine, Social Insurance Chuo General Hospital |
| [ Summary ] | Ulcerative colitis (UC) is a chronic inflammatory bowel disease of the colonic mucosa. For decades, corticosteroids have been used as the standard treatment for patients with moderate to severe active UC, while patients with severe disease who failed to respond to steroids inevitably had to undergo colectomy. Recently, the immunosuppressive drug cyclosporin (CsA) has been used as an alternative medication in patients with severe steroid refractory UC and has shown efficacy in reducing colectomy rates. Patients who failed to respond to steroid were given intravenous CsA at 3 - 4 mg / kg / day for 14 days. During CsA infusion, the blood level of CsA was adjusted to 400 - 600 ng / ml. Patients who did not show improvement after 14 days of CsA therapy had to undergo colectomy. Patients who clinically and endoscopically responded to CsA were switched to oral CsA at a dose of 8 mg / kg / day (twice the intravenous dose) together with 5-aminosalicylate. Steroid dosage was gradually reduced and oral CsA was discontinued within 6 months of initiation. Intravenous CsA therapy in patients with severe UC is rapidly effective in inducing remission and reducing colectomy rates. However, oral CsA does not show efficacy in maintaining remission. The strategy of adding azathioprine or 6-mercaptopurine (AZA/6-MP) to maintain remission induced by CsA is usually recommended. Further, as AZA/6-MP may take 3 - 4 months to show full efficacy, use of oral CsA as a “bridge therapy” until AZA/6-MP becomes effective may be valuable. |
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