Forecasting Cyclosporine Success or Failure

Permanente Medical Group, Walnut Creek, California, USA.
Inflammatory Bowel Diseases (Impact Factor: 5.48). 01/2009; 15(1):152-3. DOI: 10.1002/ibd.20503
Source: PubMed
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    ABSTRACT: Cyclosporin-A (CSA) has been demonstrated to be effective for treatment of severe, steroid-resistant ulcerative colitis (UC). Use of CSA has been limited, however, because of low 1-yr response rates and the potential for complications. The aim of this study is to define clinical and laboratory factors predictive of response in severe, steroid-resistant UC. A retrospective review of 36 cases of severe, steroid-resistant UC treated with CSA was performed. Intravenous (i.v.) CSA was administered at an initial dose of 2.5 mg/kg, and oral (p.o.) CSA was given as twice the i.v. dose. Clinical response was recorded and logistic regression analysis was performed on clinical and laboratory factors for prediction of response to CSA. Of 36 patients, 25 responded to i.v. CSA and were switched to p.o. CSA. Of the 25, 13 required colectomy by 9 months. The other 12 patients had a sustained response to CSA and avoided colectomy at 9 months. Overall, 24 of 36 patients treated with CSA required colectomy by 9 months. A high percentage of band neutrophils (bands) on admission was found to be a significant predictor of response to CSA. Bands on admission are predictive of response to CSA and ultimately, the requirement for surgery in steroid-resistant UC.
    The American Journal of Gastroenterology 09/2000; 95(8):2000-8. DOI:10.1111/j.1572-0241.2000.02186.x · 9.21 Impact Factor
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    ABSTRACT: The authors have produced a unique study of 624 patients with ulcerative colitis for they have achieved a 100% follow-up of all these patients admitted to the Radcliffe Infirmary or to the Churchill Hospital, Oxford, from 1938 to March 1962 inclusive or who attended as out-patients during the same period. They are therefore able to present a most important analysis of the natural history of ulcerative colitis as it occurs in the general population. Part I concerns the short-term prognosis in the initial attack, Part II the long-term prognosis; Part III discusses the complications of the disease, and Part IV the risk of carcinoma.
    Gut 01/1964; 4:299-315. · 13.32 Impact Factor
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    ABSTRACT: There has been no new effective drug therapy for patients with severe ulcerative colitis since corticosteroids were introduced almost 40 years ago. In an uncontrolled study, 80 percent of 32 patients with active ulcerative colitis refractory to corticosteroid therapy had a response to cyclosporine therapy. We conducted a randomized, double-blind, controlled trial in which cyclosporine (4 mg per kilogram of body weight per day) or placebo was administered by continuous intravenous infusion to 20 patients with severe ulcerative colitis whose condition had not improved after at least 7 days of intravenous corticosteroid therapy. A response to therapy was defined as an improvement in a numerical symptom score (0 indicated no symptoms, and 21 severe symptoms) leading to discharge from the hospital and treatment with oral medications. Failure to respond to therapy resulted in colectomy, but some patients in the placebo group who had no response and no urgent need for surgery were subsequently treated with cyclosporine. Nine of 11 patients (82 percent) treated with cyclosporine had a response within a mean of seven days, as compared with 0 of 9 patients who received placebo (P < 0.001). The mean clinical-activity score fell from 13 to 6 in the cyclosporine group, as compared with a decrease from 14 to 13 in the placebo group. All five patients in the placebo group who later received cyclosporine therapy had a response. Intravenous cyclosporine therapy is rapidly effective for patients with severe corticosteroid-resistant ulcerative colitis.
    New England Journal of Medicine 06/1994; 330(26):1841-5. DOI:10.1056/NEJM199406303302601 · 54.42 Impact Factor