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P452. Long-term efficacy and safety of cyclosporine as a rescue therapy in acute, steroid-refractory severe ulcerative colitis

A. Balint1, K. Farkas1, Z. Szepes1, F. Nagy1, S. Monika2, T. Wittmann1, T. Molnar1, 1University of Szeged, First Department of Medicine, Szeged, Hungary, 2University of Szeged, Department of Medical Physics and Informatics, Szeged, Hungary

Background

Although cyclosporine is an accepted and effective therapeutic choice in patients with severe ulcerative colitis (UC), long term colectomy rate varies between 60–88% among patients in whom cyclosporine initially induced remission. The aim of our study was to evaluate the long-term outcome and the optimal duration of cyclosporine therapy in patients with acute, severe UC.

Methods

73 (40 females, 33 males; mean age at the diagnosis 31.7 years, mean disease duration 13.4 years) of 183 patients hospitalized for severe exacerbation of UC between January 1998 and June 2009 revealed steroid-refractory after intravenous methylprednisolone therapy. They underwent intravenous cyclosporine treatment for 5 days following oral treatment in the case of a good initial response.

Results

The mean follow up after the initiation of cyclosporine therapy was 4.2 years. The median duration of cyclosporine therapy was 9.6 months. Side effects developed in 37 patients. 20 patients underwent early colectomy. Cyclosporine therapy had to be discontinued due to intolerable or severe side effects in 22 patients. Cyclosporine failed and late colectomy was performed in 14 of the 53 responders during the long-term follow up. Duration of cyclosporine treatment was significantly longer in those who avoided colectomy (5.4 vs. 13.3 months, p = 0.009). The optimal cut-point of the duration of cyclosporine therapy to avoid colectomy was 4.5 months. No association was revealed between the duration of cyclosporine therapy and the development of side effects.

Conclusion

Cyclosporine is effective in acute, severe UC. After a median follow up of more than 4 years, 53.4% of the patients remained colectomy free. The optimal time for cyclosporine treatment proved to be 4.5 months.