| Theme | Novel therapeutic strategy for ulcerative colitis | |
|---|---|---|
| Title | The short-term efficacy and positioning of intravenous cyclosporine therapy in patients with severe steroid-refractory ulcerative colitis | |
| Publish Date | 2013/03 | |
| Author | Naoki Yoshimura | Department of Internal Medicine, Division of IBD, Social Insurance Central General Hospital |
| Author | Masakazu Takazoe | Department of Internal Medicine, Division of IBD, Social Insurance Central General Hospital |
| [ Summary ] | Recently, the immunosuppressive agent, cyclosporineA (CsA) has been introduced as an alternative medication for patients with severe steroidrefractory ulcerative colitis (UC). Up to 80 % of patients with severe UC are refractory to steroid treatment and respond to CsA, potentially avoiding colectomies. It would appear that rates of remission in patients with severe UC improve with CsA therapy. At this time, the calcineurin inhibitors, tacrolimus (Tac), anti-TNF antibody and infliximab (IFX) have been approved as rescue therapies to avoid colectomies for patients with severe UC who have failed to respond to steroid treatment. However, there is little evidence to prove clinical comparative responses to these three medications. In terms of remission rates for severe UC cases in the CsA group, 40 out of 53 patients in the severely affected group (75.5 %) and 10 out of 19 in the fluminant group (52.6 %) achieved induced remission versus 19 out of 23 (82.6 %) and 2 out of 7 (28.6 %) in the Tac group, as well as 12 out of 15 (80 %) and 1 out of 4 (25.0 %) in the IFX group. In terms of management for patients with severe UC, the initial efficacy and safety of CsA, Tac and IFX showed no significant difference. For fluminant UC therapy, CsA treatment may be superior in terms of avoiding colectomies. |
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