CYCLOSPORIN-INDUCED REMISSION IN SEVERE COLITIS UNRESPONSIVE TO CORTICOSTEROID THERAPY

Abstract

Cyclosporln A (CyA) has induced clinical remission in Crohn's disease and one adult with ulc colitis. We have documented remission in disease activity and mucosal inflammation hy sequential biopsies in two adolescents with severe pancolitis unresponsive to IV corticesteroids and TPN. Patient #1 has UC and pt #2 pancolitis (indeterminate type). Patient #1 had persistent bleeding requiring 10 u of blood. After 4 wks of IV Solu-Medrol and TPN, IV CyA 160 mg BID (6 mg/kg/day) was begun. Plasma Cy by HPLC was 200 ng/ml. At one week, stools decreased and gross bleeding subsided. Biopsies on day 7 had reduced PMN infiltration. At day 14, no crypt abscesses were seen; PMN inflammation was minimal at 5-10 cm and normal at 15 cm. Pred was tapered to 20 rag QOD. After 5 mos of oral CyA rx, she is asymptomatic, with mild friability to 10 cm and normal from 10-25 cm. Patient #2 had severe abd pain, hematochezia and wt loss, non responsive to 4 wks of pred and 3 wks of IV Solu-Medrol. IV CyA, 130 mg BID, (6mg/kg/day) was followed by gradual improvement over 2 wks. A decrease in mucosal inflammation was noted at 3 wks and markedly improved at 6 wks. At 3 mos, she is asymptomatic on oral CyA and alt day pred wi th mild rectal edema. Conclusion: CyA reduces inflammation and induces clinical remission which lasts for at least 3-6 mos. A multicenter study of CyA in pediatric patients with severe colitis, unresponsive to corticosteroid therapy, should be established.