P556 Cyclosporine in acute severe steroid-refractory ulcerative colitis: Short-and long-term outcomes

Abstract

Intravenous cyclosporine (CSA) therapy followed by oral cyclosporine therapy has been shown to be effective in steroid-refractory ulcerative colitis (UC) reducing the need for urgent colectomy. However, the long-term benefits of cyclosporine remain questionable. The aim of this study is to evaluate the short- and long-term efficacy of CSA in patients with acute severe UC refractory to corticosteroids. We conducted a retrospective study icluding all patients admitted in our department for acute severe UC refractory to corticosteroids, treated with intravenous CSA and then oral CSA between January 2007 and December 2016. A total of 76 patients with severe steroid-refractory ulcerative colitis were treated with intravenous CSA (2 mg/kg/day), for a mean period of 7.8 days [7–10 days]. Forty-six patients (68, 7%) responded to intravenous CSA and avoided colectomy during hospitalisation. Twenty-one (45, 65%) were males and 25 (54, 34%) were females with a mean age of 32, 78 years [14–61 years]. Subsequently the patients were started on oral cyclosporine (4 mg/kg/day) and followed for a mean of 37months (6 months–10 years). All patients received azathioprine (AZA) for maintaining remission after response to CSA therapy. During follow-up, 22 patients (47, 8%) treated with AZA developed new attacks with a mean time of 15, 6 months [2–48 months]. Anti-TNF therapy was prescribed to five relapsing patients, while nine patients (19, 56%) required colectomy for new severe attack of UC. At the end of the follow-up, clinical-remission was maintained in 24 cases (52, 2%). Our study shows that Cyclosporine therapy is an effective treatment for acute severe steroid-refractory UC in the short term. Although long remission was maintained in more than half of the patients, colectomy rate after response to CSA remain relatively high in the longer term (20% in our study).