Tacrolimus for Remission Induction and Maintenance Therapy in Patients with Ulcerative Colitis: A Retrospective Evaluation Study.

Ayumi Ito,Shinichi Nakamura,Katsutoshi Tokushige,Teppei Omori,Bunei Iizuka

doi:10.1155/2016/5956316

Ayumi Ito, Shinichi Nakamura + Show 3 more

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https://doi.org/10.1155/2016/5956316

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Abstract

Background. In this retrospective study, we compared the efficacy of tacrolimus (TAC) or prednisolone (PSL) for maintenance therapy in patients with ulcerative colitis (UC) at remission. Methods. The study patients were followed up for at least one year after induction of remission with either PSL (n = 55, between April 2004 and March 2014) or TAC (n = 40, between April 2009 and March 2014). The clinical features and relapse rates were compared in the two groups. Maintenance therapy in the TAC group included TAC alone, AZA alone, and TAC plus AZA. Results. The recurrence rates at 1500 days after remission were 61% and 46% for the PSL and TAC groups, respectively (P < 0.05). The recurrence rates at 600 days for TAC, AZA, and TAC + AZA maintenance groups were 24%, 49%, and 55%, respectively. Nephrotoxicity developed in 16 patients on TAC maintenance therapy. Conclusions. TAC monotherapy is a potential alternative especially for PSL nonresponders or those intolerant to AZA. However, patients on TAC therapy should be regularly monitored for adverse effects including nephrotoxicity.

Highlights

Ulcerative colitis (UC) is a chronic relapsing and remitting inflammatory bowel disease (IBD), which afflicts millions of individuals throughout the world with debilitating symptoms, impaired performance, and poor quality of life [1]
The two groups (Figure 1) were compared with respect to the following variables: gender, age, disease duration, extent of ulcerative colitis (UC), history of AZA therapy, pretreatment clinical activity index (CAI) according to Lichtiger et al [10], duration of hospital stay, total dose of PSL until remission, discontinuation of PSL after remission, pretreatment hemoglobin (Hb) and C-reactive protein (CRP) levels, the Mayo Endoscopic Scoring of Ulcerative Colitis [16], Ulcerative Colitis Endoscopic Index of Severity (UCEIS) [11], endoscopic activity index (EAI) [12], total dose of PSL during hospitalization, and discontinuation of PSL after induction of remission and latency to recurrence after induction of remission (Table 1)
There were no significant differences between the PSL group and the TAC group with respect to the gender ratio, age, UC severity level, past AZA therapy, pretreatment Hb, and CRP

Summary

Introduction

Ulcerative colitis (UC) is a chronic relapsing and remitting inflammatory bowel disease (IBD), which afflicts millions of individuals throughout the world with debilitating symptoms, impaired performance, and poor quality of life [1]. Routine management of UC requires administration of high doses of PSL for the treatment of acute severe flares and discontinuation of PSL after the induction of remission to minimize the side effects. In this retrospective study, we compared the efficacy of tacrolimus (TAC) or prednisolone (PSL) for maintenance therapy in patients with ulcerative colitis (UC) at remission. The recurrence rates at 1500 days after remission were 61% and 46% for the PSL and TAC groups, respectively (P < 0.05). The recurrence rates at 600 days for TAC, AZA, and TAC + AZA maintenance groups were 24%, 49%, and 55%, respectively. Patients on TAC therapy should be regularly monitored for adverse effects including nephrotoxicity

Methods

Results

Conclusion