Intravenous ciclosporin for acute, severe colitis is usually administered in a dose of 4 mg/kg/day, with concurrent intravenous steroids. This high-dose regimen is associated with considerable morbidity.
Professor M Kamm and colleagues at St. Mark’s Hospital in London, UK have been using a reduced ciclosporin dose of 2mg/kg/day to treat acute, severe colitis for the past 7 years. In most cases ciclosporin was given without concurrent steroids.
The outcome of the low-dose ciclosporin regimen is presented by Professor Kamm’s team in the August issue of Alimentary Pharmacology and Therapeutics.
31 patients with acute-severe ulcerative colitis were treated with low-dose ciclosporin for a median of 8 days. 77% of these patients avoided urgent colectomy and were discharged on oral ciclosporin and azathioprine.
After a median of 18 months follow up, 45% of patients managed to avoid colectomy.
Morbidity as a result of the low dose regimen appeared to be low. Three patients had hypertension requiring dose reduction, one elevated creatinine and one elevated liver enzymes.
| Low-dose intravenous ciclosporin used as a monotherapy and followed by azathioprine achieves similar long-term efficacy to higher dose ciclosporin combined with steroids.|
|Alimentary Pharmacology and Therapeutics|
Four patients experienced infection, two with arm cellulitis, one with a perianal abscess, and one with post-operative wound infection.