Sood Ajit, Midha Vandana, Sood Neena, Mehta Varun, Jain Savita, Garg Shweta, Puri Sandeep
Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, India.
Indian J Gastroenterol. 2008 Nov-Dec;27(6):232-5.
Cyclosporine A (CsA) has been found to be the first successful therapy used in the recovery of patients with steroid-refractory ulcerative colitis (UC). However, the long-term benefits of cyclosporine remain questionable. We report our results on the use of CsA in patients with severe steroid-refractory UC.
The records of all patients with steroid refractory UC treated with CsA from January 2003 to December 2007 were reviewed. Demographics, clinical characteristics of the disease, responsiveness to CsA, complications arising from the treatment and the need for surgery were recorded for all patients.
Of 146 admissions of severe UC, 24 patients who were steroid refractory (mean age 41.7 years; 11 men) received intravenous cyclosporine (4 mg/kg/day) for mean of 6.63 days (range 1-7), followed by oral CsA for a period of 3 months. All patients had failed to respond to intravenous hydrocortisone given for 7 days. Four patients required a colectomy immediately, three of whom failed to respond to CsA, and one had convulsions following drug administration. Nineteen of the 24 patients (79%), in whom a colectomy was avoided during the early stages of their treatment, were followed up for a mean of approximately 38 months (range 12-62 months). Three patients required surgery on follow up; one was operated at day 94, another in the second year and one in the third year. Overall, 16 of 24 patients (67%) remained colectomy-free. The main side-effects observed included infections, tremors, paresthesias, headache, hypertension, hypertrichosis and peripheral neuropathy. Three of seven patients who had to undergo surgery died within 2 weeks.
Our study shows that surgery can be avoided in two-thirds of patients with steroid refractive severe UC. However, the drug toxicity and mortality are significant.
环孢素A（CsA）已被发现是用于治疗类固醇难治性溃疡性结肠炎（UC）患者康复的首个成功疗法。然而，环孢素的长期益处仍存在疑问。我们报告了使用CsA治疗重度类固醇难治性UC患者的结果。
回顾了2003年1月至2007年12月期间所有接受CsA治疗的类固醇难治性UC患者的记录。记录了所有患者的人口统计学信息、疾病的临床特征、对CsA的反应、治疗引起的并发症以及手术需求。
在146例重度UC患者中，24例类固醇难治性患者（平均年龄41.7岁；11名男性）接受静脉注射环孢素（4mg/kg/天），平均6.63天（范围1 - 7天），随后口服CsA 3个月。所有患者对静脉注射氢化可的松7天均无反应。4例患者立即需要进行结肠切除术，其中3例对CsA无反应，1例在给药后出现惊厥。24例患者中有19例（79%）在治疗早期避免了结肠切除术，平均随访约38个月（范围12 - 62个月）。3例患者在随访期间需要手术；1例在第94天手术，另1例在第二年，1例在第三年。总体而言，24例患者中有16例（67%）未进行结肠切除术。观察到的主要副作用包括感染、震颤、感觉异常、头痛、高血压、多毛症和周围神经病变。7例必须接受手术的患者中有3例在2周内死亡。
我们的研究表明，三分之二的类固醇难治性重度UC患者可以避免手术。然而，药物毒性和死亡率很高。
