Experience of Cyclosporine A Therapy in Severe Ulcerative Colitis Refractory to Steroid Treatment

Lee, Dae Hee; Lee, Jun Haeng; Park, Dong Young; Kim, Yoon Jun; Hwang, Jin Hyok; Cha, Sung Duk; Jeong, Woon Tae; Yoon, Jung Hwan; Lee, Kook Lae; Lee, Dong Ho; Jung, Hyun Chae; Song, In Sung; Choi, Kyoo Wan; Kim, Chung Yong

Abstract

BACKGROUND AND AIMS: In refractory severe ulcerative colitis patients who are resistant to intravenous corticosteroids and total parenteral nutrition, new medical therapeutic tools that induce rapid remission is required in order that the patients can avoid colectomy. Since 1990, several western groups reported in their well designed studies that cyclosporine A cou)d induce rapid remission at steroid resistant severe ulcerative colitis patients resulting avoidance of colectomy. We tested the effectiveness of intravenous cyclosporine A therapy at steroid resistant severe ulcerative colitis patients in Korea, which has little experiences in the management of steroid resistant severe ulcerative colitis.
METHODS
Seven patients were included who were refractory to intravenous corticosteroids and total parenteral nutrition of at least 4 weeks duration. Their liver function tests and creatinine clearance tests were all normal. Cyclosporine A were administered by continuous intravenous methods over 6 hours or 24 hours. The starting doses of cyclosporine A were 4 mg/kg. The blood level was monitored by radioimmunoassay with a monoclonal antibody. The doses were adjusted at blood level from 100 ng/ml to 400ng/ml. In one patient cyclosporine A was administered for only 4 days because of rapid aggravation and consequent emergency operation. In another 6 patients cyclosporine A were administered for 14 days.
RESULTS
Four patients revealed scores of less than 10 by clinical activity scores system. But, in spite of improvement by scores, 3 patients of above 4 responders exhibited persistent gross hematochezias at frequencies of more than 3 times a day. Therefore operations were recommended in 6 patients. But one patient refused operation and is under OPD follow up with oral cyclosporine A and corticosteroids medications but he exhibits persistent gross hematochezia at a frequency of 3 or 4 tirnes a day. Out of 5 patients who were operated, 4 patients were cured by operations but 1 patient died because of postoperational sepsis.
CONCLUSIONS
We found that the intravenous cyclosporine A therapy produced some improvement by clinical activity scores in 4 patients out of 7 patients but induced clinical remission of gross hematochezia in only 1 patient. Therefore operation could be avoided in only 1 patient. This result suggests that the response of Korean patients to intravenous cyclosporine A therapy would be different from that of western people. However, many another studies, especially case control studies are required to clarify this possibility and to assign the proper role of intravenous cyclosporine A therapy in the manageent of patients with ulcerative colitis in Korea.