Ciclosporin as salvage therapy in steroid-refractory ulcerative colitis: a nurse's guide

Abstract

Ciclosporin is an immunosuppressant drug used to treat severe exacerbations of ulcerative colitis (UC). In mild UC, remission is achieved and maintained with the aminosalicylate mesalazine. Patients hospitalised with severe flares are usually treated with steroids. If steroids are contraindicated or ineffective, surgery can be avoided with rescue therapy using either infliximab or ciclosporin. As a treatment for acute, steroid-refractory colitis, intravenous ciclosporin is fast acting and effective, with a 58% success rate. However, it remains unlicensed in the UK, due to associated side effects and drug interactions. Although ciclosporin is not the most frequently used drug in UC, it remains an important option to understand, to help patients avoid surgery. This article is a guide to the safe use of ciclosporin to treat acute UC in the hospital setting, covering pre-infusion screening, infusion preparation and treatment monitoring. It also covers how to detect and respond to drug reactions and provide appropriate follow-up treatment should the intravenous course of ciclosporin be successful.