Intravenous Glucocorticoid Therapy Research Articles

Clinical efficacy of intravenous glucocorticoid treatment in Graves’ ophthalmopathy

Abstract Objective To assess the efficacy of intermittent, high-dose treatment with intravenous glucocorticoids (IV GCs) in moderate to severe Graves’ ophthalmopathy (GO). Materials and methods Patients with GO treated with IV GCs from August 2007 to August 2011 at the Endocrinology Department of Reina Sofia Hospital were enrolled into the study. IV pulse prednisolone (7.5 mg/kg/day) was administered twice weekly every two weeks for 6 weeks, and at half the dose for 6 additional weeks. Results Eighteen patients (mean age, 43 ± 11 years) with moderate to severe GO were analyzed (83.3% females). Four were active smokers, five former smokers, and the rest had never smoked. Hyperthyroidism due to Graves’ disease was found in 66.7% of patients, 41.6% of whom had received radioiodine therapy. Response to treatment was satisfactory in 72.2%, partial in 11.1%, and poor in 16.7%. Mild side effects were reported by 5 patients. Before treatment, 83.3% had diplopia, 33.3% eyelid retraction, 72.2% eye pain, and 44.4% exophthalmos. After treatment, only 33.3% had diplopia ( P = .004), 5.6% eyelid retraction ( P = .063), 16.7% eye pain ( P = .002), and 11.1% exophthalmos ( P = .031). Response to treatment was not related to the underlying disease ( P = .866), prior radioiodine treatment ( P = .447), or smoking status ( P = .368). Conclusions Intravenous glucocorticoid therapy decreased activity in patients with moderate to severe active GO, with major improvement occurring in diplopia, eye pain, and exophthalmos. Side effects were mild and uncommon. Treatment response was independent from the underlying disease, prior radioiodine treatment, or smoking status.

Evaluación de la efectividad del tratamiento con glucocorticoides intravenosos en la oftalmopatía de Graves

To assess the efficacy of intermittent, high-dose treatment with intravenous glucocorticoids (IV GCs) in moderate to severe Graves' ophthalmopathy (GO).Patients with GO treated with IV GCs from August 2007 to August 2011 at the Endocrinology Department of Reina Sofía Hospital were enrolled into the study. IV pulse prednisolone (7.5 mg/kg/day) was administered twice weekly every two weeks for 6 weeks, and at half the dose for 6 additional weeks.Eighteen patients (mean age, 43 ± 11 years) with moderate to severe GO were analyzed (83.3% females). Four were active smokers, five former smokers, and the rest had never smoked. Hyperthyroidism due to Graves' disease was found in 66.7% of patients, 41.6% of whom had received radioiodine therapy. Response to treatment was satisfactory in 72.2%, partial in 11.1%, and poor in 16.7%. Mild side effects were reported by 5 patients. Before treatment, 83.3% had diplopia, 33.3% eyelid retraction, 72.2% eye pain, and 44.4% exophthalmos. After treatment, only 33.3% had diplopia (P=.004), 5.6% eyelid retraction (P=.063), 16.7% eye pain (P=.002), and 11.1% exophthalmos (P=.031). Response to treatment was not related to the underlying disease (P=.866), prior radioiodine treatment (P=.447), or smoking status (P=.368).Intravenous glucocorticoid therapy decreased activity in patients with moderate to severe active GO, with major improvement occurring in diplopia, eye pain, and exophthalmos. Side effects were mild and uncommon. Treatment response was independent from the underlying disease, prior radioiodine treatment, or smoking status.

High-Dose Intravenous Glucocorticoid Therapy for Graves' Ophthalmopathy: Where Are We Now?

High-Dose Intravenous Glucocorticoid Therapy for Graves' Ophthalmopathy: Where Are We Now?

The relationship between adenosine triphosphate within CD4+ T lymphocytes and acute rejection after liver transplantation

There have been increasing interests in the relationship between CD4(+) T lymphocytes and acute rejection (AR) in transplantation. In this study, we explore the role of CD4(+) T lymphocytes after liver transplantation. From February to October 2009, 87 patients underwent liver transplantation. They were divided into the AR group and non-acute rejection (NAR) group, with 56 healthy individuals in the control group. Blood specimens were collected preoperatively and at one, two, and four wk postoperatively for all groups and also on the day when AR occurred and one wk after intravenous glucocorticoid therapy for the AR group. Adenosine triphosphate (ATP) levels were measured using the ImmuKnow™ test kits for immune cell functions. After transplantation, the ATP levels within CD4(+) T lymphocytes were significantly elevated in the two groups when compared with the preoperative levels. It peaked in the AR group and was significantly higher than that of the NAR group (p < 0.05). By ROC curve analysis, the obvious elevation of the ATP value one wk after transplantation had better sensitivity and specificity in diagnosing the AR. The ATP sensitivity rate for early AR was 85.7% and specificity rate 80.9% when the cutoff value was 407 μg/L. The ATP value collected on the day of AR occurrence has apparently positive correlation with the rejection acting index (RAI) (p < 0.01). After the intravenous glucocorticoid therapy, all the ARs were reversed and the ATP value declined significantly compared with the control group and that on the day when AR occurred (p < 0.01). During the early postoperative period (especially at first week after liver transplantation), the elevation of ATP levels within CD4(+) T lymphocytes has good sensitivity and specificity in diagnosing the AR at early stage. And the degree of AR has positive relationship with ATP value. After the intravenous glucocorticoid therapy, the obvious declination of AR might be used in evaluating the effectiveness of anti-rejection treatment.

Orbital magnetic resonance imaging combined with clinical activity score can improve the sensitivity of detection of disease activity and prediction of response to immunosuppressive therapy for Graves' ophthalmopathy

The aim of this study was to demonstrate that the addition of orbital magnetic resonance (MR) imaging can provide improvement in sensitivity of detection of active disease and the prediction of the response to intravenous glucocorticoid therapy (ivGC), over clinical activity score (CAS) alone. A prospective case series was studied at our institution. Forty eight patients were examined by CAS and orbital MR imaging. The maximum of T2 relaxation times of extraocular muscles (maxT2RT) and other parameters were evaluated by MR imaging. Thirty five of 48 patients underwent ivGC. Twenty of 35 patients, whose CAS was 2 points or less, were evaluated for the response to ivGC. The correlation between CAS and maxT2RT was evaluated. Differentiation of active and inactive GO was performed by CAS and orbital MR imaging. The response to ivGC was evaluated by CAS, orbital MR imaging and ophthalmic parameters. As a result, CAS and maxT2RT showed significant positive correlation (r=0.58, p<0.0001), and 15 patients were positive by CAS and orbital MR imaging. However, 20 patients were positive by only MR imaging. In those 20 patients, there was significant improvement after ivGC. We concluded that orbital MR imaging combined with CAS could improve the sensitivity of detection of active disease and the prediction of the response to ivGC. In addition, even if only one parameter of CAS is positive, further examination with orbital MR imaging is advised.

Cardiovascular and Cerebrovascular Events in Temporal Relationship to Intravenous Glucocorticoid Pulse Therapy in Patients with Severe Endocrine Ophthalmopathy

ThyroidVol. 19, No. 12 Letters to the EditorCardiovascular and Cerebrovascular Events in Temporal Relationship to Intravenous Glucocorticoid Pulse Therapy in Patients with Severe Endocrine OphthalmopathyMaria E. Lendorf, Åse Krogh Rasmussen, Hans C. Fledelius, and Ulla Feldt-RasmussenMaria E. LendorfDepartment of Ophthalmology, National University Hospital, Rigshospitalet, Copenhagen, Denmark.Search for more papers by this author, Åse Krogh RasmussenDepartment of Medical Endocrinology, National University Hospital, Rigshospitalet, Copenhagen, Denmark.Search for more papers by this author, Hans C. FledeliusDepartment of Ophthalmology, National University Hospital, Rigshospitalet, Copenhagen, Denmark.Search for more papers by this author, and Ulla Feldt-RasmussenDepartment of Medical Endocrinology, National University Hospital, Rigshospitalet, Copenhagen, Denmark.Search for more papers by this authorPublished Online:14 Dec 2009https://doi.org/10.1089/thy.2009.0069AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Cardiovascular and Cerebrovascular Events in Temporal Relationship to Intravenous Glucocorticoid Pulse Therapy in Patients with Severe Endocrine Ophthalmopathy." , 19(12), pp. 1431–1432FiguresReferencesRelatedDetailsCited byDrug safety in thyroid eye disease – a systematic review15 August 2022 | Expert Opinion on Drug Safety, Vol. 21, No. 7Safety of Intravenous Methylprednisolone in Refractory and Severe Pediatric Uveitis1 May 2022 | Clinical Ophthalmology, Vol. Volume 16Comparison of efficacy and safety of parenteral versus parenteral and oral glucocorticoid therapy in Graves’ orbitopathy2 August 2020 | International Journal of Clinical Practice, Vol. 74, No. 11Glucocorticoids in Graves’ orbitopathy: mechanisms of action and clinical application14 December 2020 | Therapeutic Advances in Endocrinology and Metabolism, Vol. 11Acute bilateral cerebral infarction in the presence of neuromyelitis optica spectrum disorder2 October 2020 | Medicine, Vol. 99, No. 40Life-threatening complications of high doses of intravenous methylprednisolone for treatment of Graves’ orbitopathy23 December 2019 | Thyroid Research, Vol. 12, No. 1Methotrexate as an Adjuvant in Severe Thyroid Eye Disease: Does It Really Work as a Steroid-Sparing Agent?Ophthalmic Plastic & Reconstructive Surgery, Vol. 35, No. 4Endocrine orbitopathy: the present view of a clinical endocrinologistVnitřní lékařství, Vol. 63, No. 10Retracted : Efficacy and safety of mycophenolate mofetil in patients with active moderate‐to‐severe Graves’ orbitopathy7 September 2016 | Clinical Endocrinology, Vol. 86, No. 2Management of Dysthyroid Optic Neuropathy17 December 2016THERAPY OF ENDOCRINE DISEASE: Endocrine dilemma: management of Graves’ orbitopathyEuropean Journal of Endocrinology, Vol. 175, No. 3Prospectively recorded and MedDRA-coded safety data of intravenous methylprednisolone therapy in Graves’ orbitopathy10 January 2015 | Journal of Endocrinological Investigation, Vol. 38, No. 2Safety Profile and Effects of Pulsed Methylprednisolone on Vital Signs in Thyroid Eye DiseaseInternational Journal of Endocrinology, Vol. 2015Thyroid Eye Disease: A Comprehensive ReviewMeta-analysis of methylprednisolone pulse therapy for Graves' ophthalmopathy4 April 2014 | Clinical & Experimental Ophthalmology, Vol. 42, No. 8A Prospective, Randomized Trial of Intravenous Glucocorticoids Therapy With Different Protocols for Patients With Graves' OphthalmopathyThe Journal of Clinical Endocrinology & Metabolism, Vol. 99, No. 6Efficacy and Safety of Three Different Cumulative Doses of Intravenous Methylprednisolone for Moderate to Severe and Active Graves' OrbitopathyThe Journal of Clinical Endocrinology & Metabolism, Vol. 97, No. 12Treatment of mild, moderate-to-severe and very severe Graves’ orbitopathyBest Practice & Research Clinical Endocrinology & Metabolism, Vol. 26, No. 3Treatment options for Graves' orbitopathy9 March 2012 | Expert Opinion on Pharmacotherapy, Vol. 13, No. 6Fatal and non-fatal adverse events of glucocorticoid therapy for Graves' orbitopathy: a questionnaire survey among members of the European Thyroid AssociationEuropean Journal of Endocrinology, Vol. 166, No. 2Corticotrophins, corticosteroids, and prostaglandins Volume 19Issue 12Dec 2009 InformationCopyright 2009, Mary Ann Liebert, Inc.To cite this article:Maria E. Lendorf, Åse Krogh Rasmussen, Hans C. Fledelius, and Ulla Feldt-Rasmussen.Cardiovascular and Cerebrovascular Events in Temporal Relationship to Intravenous Glucocorticoid Pulse Therapy in Patients with Severe Endocrine Ophthalmopathy.Thyroid.Dec 2009.1431-1432.http://doi.org/10.1089/thy.2009.0069Published in Volume: 19 Issue 12: December 14, 2009Online Ahead of Print:November 7, 2009PDF download

A Case of Intravenous Pamidronate-Related Osteonecrosis of the Jaw in a Patient with Waldenstrom's Macroglobulinemia

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a rare, but serious, side effect of bisphosphonate therapy that produces significant morbidity in affected patients. It is characterized by poor wound healing and spontaneous intra-oral soft tissue breakdown, which lead to exposure of necrotic maxillary and mandibular bone. We report a case of BRONJ in 56-year-old man who visited Ajou University Hospital Dental Clinic in March 2007. He had been diagnosed with Waldenstrom's macroglobulinemia in 2005 and had been treated with chemotherapeutic agents, along with concomitant pamidronate injections (45 mg monthly). The patient had clinical features of bisphosphonate-related osteonecrosis of the mandible precipitated by tooth extraction. The patient had multiple systemic risk factors, including extended duration of intravenous pamidronate therapy, chemotherapy, and glucocorticoid therapy for his malignancy. In the 6 months prior to presentation, curettage and debridement were performed repeatedly, but there was no improvement in the mandibular lesion. The patient was referred to the Endocrinology Clinic and was diagnosed with BRONJ. We discontinued pamidronate and started conservative care. BRONJ should be considered in the differential diagnosis when patients complain of poor oral wound healing or have recurrent exposure of necrotic maxillary and mandibular bone. (J Korean Endocr Soc 23:210~214, 2008)

A treatment strategy for Graves' orbitopathy

A 59-year-old woman with a history of nodular goiter developed thyrotoxic symptoms while on levothyroxine therapy. Her thyrotoxicosis persisted after levothyroxine withdrawal, so she was given methimazole and, once euthyroid, underwent near-total thyroidectomy. Histological examination revealed a nodular variant of Graves' disease. Proptosis, eyelid swelling and diplopia appeared 2 months after surgery. These symptoms worsened, and the patient was initially given four intravenous pulses of glucocorticoids, which resulted in a transient amelioration of her eye symptoms. After glucocorticoid withdrawal, however, the patient's eye motility worsened and there was a reduction of visual acuity in the left eye. She was then referred to our hospital for further advice and treatment. Complete thyroid and ophthalmological evaluation, computerized visual field analysis, CT scan of the orbits, routine blood tests, search for occult fecal blood, blood tests for hepatitis B and C virus markers, measurements of serum non-organ-specific autoantibodies and serum anti-TSH-receptor antibodies, and liver ultrasonography. Nodular Graves' disease with severe, active Graves' orbitopathy complicated by optic neuropathy. Intravenous glucocorticoid therapy for 3 consecutive days, followed by once-weekly pulses of intravenous glucocorticoids over a 10-week period, and then by oral prednisone treatment on alternate days for 2 months. During the first 2 weeks of intravenous glucocorticoid therapy the patient received orbital irradiation. Therapy resulted in optimized visual acuity and a moderate improvement of soft-tissue inflammatory signs and symptoms, whereas proptosis and eye motility improved only slightly. The patient is now scheduled for orbital decompression and rehabilitative surgery.

Inflamación orbitaria apical en arteritis de la temporal

Our purpose is to describe a case of an acute optic neuropathy with apical muscle thickening in a patient already diagnosed with giant cell arteritis. Loss of visual acuity and perimetric concentric constriction responded rapidly to intravenous glucocorticoid therapy. There has been no relapse during continued long-term therapy with cyclophosphamide. Giant cell arteritis is a systemic, idiopathic vasculitis; among its less frequent complications is orbital pseudotumor. Our patient required urgent treatment to avoid visual acuity loss due to compressive neuropathy and perineuritis.

Autoimmune Hypophysitis Treated with Intravenous Glucocorticoid Therapy

A 46-year-old man presented with frontal headache, a visual field defect and general fatigue. Magnetic resonance imaging (MRI) of the brain showed symmetrical enlargement of the pituitary gland and stalk due to the presence of a mass lesion extending toward the optic chiasm. Gadolinium injection further revealed homogeneous strong enhancement with involvement of the adjacent dura (dural tail). Basal plasma levels of ACTH, free thyroxine and gonadotropins were decreased, and 24-h urinary 17-OHCS excretion was reduced. An elevated anti-thyroglobulin antibody titer indicated the presence of autoimmune thyroiditis. Under the suspicion of autoimmune hypophysitis, 60 mg/day prednisolone sodium succinate was intravenously administered for two weeks followed by a decreasing dose of oral prednisolone. Clinical symptoms and pituitary dysfunction recovered during steroid treatment and MRI showed marked shrinkage of the pituitary mass. Early initiation of an intravenous dose of glucocorticoid followed by oral steroid administration therefore seems to be an efficient treatment for autoimmune hypophysitis even in patients with visual dysfunction.

A Case of Protein-losing Enteropathy Treated with High Dose Intravenous Glucocorticoid Therapy in Systemic Lupus Erythematosus

Generalized edema and hypoalbuminemia are relatively common presenting manifestations in many clinical situations. The differential diagnosis of hypoalbuminemia include: Kwashiorkor, synthetic dysfunction of the liver, and excessive protein loss as in nephrotic syndrome. In systemic lupus erythematosus (SLE), hypoalbuminemia and generalized edema are most commonly due to protein loss associated with lupus nephritis; gastrointestinal involvement is uncommon, and therefore protein loss through the gastrointestinal tract is quite rare. We report a case of a protein losing enteropathy (PLE) associated with SLE. The patient was referred to our hospital for generalized edema, arthralgia and facial rash. After clinical evaluation, the patient met the criteria for the SLE diagnosis; hypoalbuminemia with general edema was consistent with a protein losing enteropathy. After two weeks of therapy with parenteral high dose glucocorticoid, the patients was improved in laboratory findings as well as clinical symptoms.

Acute and severe liver damage associated with intravenous glucocorticoid pulse therapy in patients with Graves' ophthalmopathy.

Acute and severe liver damage associated with intravenous glucocorticoid pulse therapy in patients with Graves' ophthalmopathy.

Relationship between longitudinal behaviour of some markers of eye autoimmunity and changes in ocular findings in patients with Graves' ophthalmopathy receiving corticosteroid therapy.

To investigate whether variations over time of TSH-receptor antibodies (TRAb) and antibodies against G2s (G2sAb) and extraocular muscles (EMAb) can predict worsening of ophthalmopathy in Graves' patients treated with intravenous glucocorticoid (IVGC) therapy. Of 65 consecutive patients with treated Graves' disease and severe and active ophthalmopathy (GO) chosen to undergo IVGC treatment, only 57 patients, persistently euthyroid under methimazole therapy, were studied longitudinally for ocular parameters, TRAb, G2sAb and EMAb before therapy, at the end of therapy and, subsequently, every month for 21 months. TRAb was detected by radioimmunoassay (RIA), G2sAb by enzyme-linked immunosorbent assay (ELISA) and EMAb by indirect immunofluorescence. Forty-three out of 57 patients (75.4%, group 1) responded positively to therapy [improvement in diplopia and decrease in proptosis and clinical activity score (CAS)] but 14 (24.6%) did not (group 2). During follow-up after IVGC therapy, 12 out of 43 patients in group 1 (28%) showed a worsening in GO (group 1a), while 31 (72%) had stable ocular conditions or further improvement (group 1b). At the start of the study, TRAb, G2sAb and EMAb were not significantly different among the three groups. At the end of IVGC therapy TRAb levels decreased significantly with respect to starting values in all three groups of patients, whereas G2sAb and EMAb decreased significantly in groups 1a and 1b but not in group 2. During the subsequent follow-up, 10 patients in group 1a one/two months before and all 12 patients at the time of GO worsening showed an increase in G2sAb and EMAb but not in TRAb, which were consistently absent or present at low titre in all patients in this group. In group 1b TRAb, G2sAb and EMAb further decreased or became negative during the follow-up period. In all patients, TRAb were positively correlated with both CAS and proptosis only at the start of the study; by contrast, a significant correlation between both G2sAb and EMAb and diplopia was observed in groups 1a and 1b at all the times during the study, except one/two months before the worsening of GO in group 1a. Our results indicate that TRAb, G2sAb and EMAb can be considered sensitive markers of Graves' ophthalmopathy during the initial stages of ophthalmopathy, but that only G2sAb and EMAb seem to be good predictive markers of the outcome in patients after corticosteroid therapy. Thus, taking into account the cost/benefit ratio, a longitudinal evaluation of either EMAb or G2sAb could be useful in monitoring the intravenous glucocorticoid therapy in patients with severe and active ophthalmopathy to predict a possible worsening of Graves' ophthalmopathy.

Interstitial pneumonitis after low-dose methotrexate therapy in primary biliary cirrhosis

Interstitial pneumonitis is an uncommon complication of low-dose methotrexate therapy in patients with psoriasis but occurs in 3%–5% of patients with rheumatoid arthritis. We found a higher incidence of interstitial pneumonitis in patients with primary biliary cirrhosis (14%) and describe its clinical manifestations, treatment, and possible etiology. Blood tests, arterial blood gas determinations, chest radiographs, bronchoscopy, tear production, autoantibody tests, and serum immunoglobulin levels were obtained in six women who developed interstitial pneumonitis while receiving methotrexate in a double-blind prospective trial of methotrexate vs. colchicine in 87 patients with primary biliary cirrhosis. Six of 43 patients (14%) who received methotrexate compared with no patients receiving colchicine developed interstitial pneumonitis 19–61 weeks after starting treatment. The pneumonitis was characterized by dyspnea, hypoxemia, and bilateral lung infiltrates, all of which responded within 24 hours to the administration of intravenous glucocorticoids. There was no correlation between the pneumonitis and pre-existing lung disease, the severity of the primary biliary cirrhosis, the titer of antimitochondrial antibody, or other diseases associated with primary biliary cirrhosis. Patients with primary biliary cirrhosis receiving low-dose methotrexate (15 mg/wk) are more susceptible to interstitial pneumonitis than patients with psoriasis or rheumatoid arthritis. The pneumonitis appears to be a hypersensitivity reaction and responds rapidly to intravenous glucocorticoid therapy.

Is intravenous glucocorticoid therapy better than an oral regimen for asymptomatic cardiac rejection? A randomized trial

Objectives. This study assessed whether treatment with oral prednisone (bolus plus tapered doses) is comparable to intravenous methylprednisolone sodium succinate (Solu-Medrol) therapy in patients with asymptomatic moderate cardiac allograft rejection episodes without hemodynamic compromise.Background. Intravenous Solu-Medrol therapy is frequently administered for moderate rejection episodes after heart transplantation but has not previously been compared with an oral prednisone therapy for asymptomatic cardiac rejection in a randomized trial. Compared with oral prednisone therapy, the administration of intravenous Solu-Medrol is more costly and resource intensive, and it can require loss of work time for patients and the family members who accompany them to treatment.Methods. Forty-one heart transplant patients with 43 episodes of asymptomatic moderate cardiac rejection were randomized to receive 3 days of 1,000 mg of intravenous Solu-Medrol (20 episodes) or prednisone as a bolus dose of 100 mg orally for 3 days, tapering to the previous maintenance dosage over 14 days (23 episodes). Follow-up endomyocardial biopsies were performed at 2 and 4 weeks. Infectious complications were monitored and the cost of the two forms of therapy was assessed.Results. Resolution of moderate rejection occurred within 4 weeks in 19 (95%) of 20 patients treated with intravenous steroids and in 21 (91%) of 23 patients treated with oral prednisone. No significant difference in infectious complications occurred between the two groups in the ensuing 3 months after therapy. The cost of the oral prednisone therapy was $6.30 compared with the cost of $180 to $966 for administration of intravenous Solu-Medrol.Conclusions. Oral prednisone (bolus plus tapered doses) appears to be as effective and to have similar infectious complication rates as intravenous Solu-Medrol for the treatment of asymptomatic cardiac rejection. The convenience and lower cost of oral prednisone therapy may warrant its routine use for this type of cardiac rejection.

Cyclosporin treatment in a corticosteroid-resistant ulcerative colitis.

A 33-year-old woman with a 7-month history of ulcerative colitis refractory to oral and intravenous glucocorticoid therapy was treated with 8 mg/kg/day of oral cyclosporin. Mucobloody diarrhea disappeared within 2 weeks of the therapy, which was accompanied with marked improvements of the colonoscopic findings. After two months of cyclosporin treatment, she underwent colectomy with ileorectal anastomosis. No complication occurred. Following the operation, the cyclosporin administration was discontinued, but the inflammation of the residual rectum has well been controlled for more than 18 months with oral sulfasalazine and to mg/day of prednisolone suppository. Finger tremer, which was the only side effect of the cyclosporin treatment, was mild and required no treatments. The results suggest that cyclosporin can be used as a remission-inducing agent in patients with active ulcerative colitis, but further investigations will be necessary to clarify the effectiveness and indication of the agent.