Azathioprine without oral ciclosporin in the long‐term maintenance of remission induced by intravenous ciclosporin in severe, steroid‐refractory ulcerative colitis

• Published in: Alimentary pharmacology & therapeutics 2002-12, Vol.16 (12), p.2061-2065
• Main Authors: Domènech, E., Garcia‐Planella, E., Bernal, I., Rosinach, M., Cabré, E., Fluvià, L., Boix, J., Gassull, M. A.
• Format: Article
• Language: English
• Subjects: Administration, Oral; Adult; Azathioprine - therapeutic use; Biological and medical sciences; Colectomy; Colitis, Ulcerative - drug therapy; Colitis, Ulcerative - surgery; Cyclosporine - therapeutic use; Drug Resistance; Drug Therapy, Combination; Female; Follow-Up Studies; Glucocorticoids - therapeutic use; Humans; Immunomodulators; Immunosuppressive Agents - therapeutic use; Injections, Intravenous; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Prednisolone - therapeutic use; Recurrence; Remission Induction; Treatment Outcome
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1046/j.1365-2036.2002.01385.x

Summary Background : Intravenous ciclosporin is considered to be the only alternative to avoid surgery in severe, steroid‐refractory ulcerative colitis. In responders, some authors recommend a switch to oral ciclosporin to act as a ‘bridge’ until the therapeutic action of azathioprine is achieved for maintenance treatment. Aim : To report the short‐ and long‐term outcome of intravenous ciclosporin‐responsive ulcerative colitis patients treated with oral azathioprine without oral ciclosporin. Methods : The records of all patients treated with intravenous ciclosporin for severe, steroid‐refractory ulcerative colitis were reviewed. Responders following treatment with azathioprine but without oral ciclosporin as maintenance therapy were included. Patients with colonic cytomegalovirus infection and/or follow‐up of less than 1 year were excluded. Results : Twenty‐seven patients were included. Steroids were discontinued in 24 (89%). The median follow‐up was 36 months. Eighteen (75%) patients presented mild or moderate relapses, which were easily managed with salicylates or steroids. Cumulative probabilities of relapse were 42%, 72% and 77% at 1, 3 and 5 years, respectively. Eleven (40.7%) patients underwent elective colectomy. Cumulative probabilities of colectomy were 29%, 35% and 42% at 1, 3 and 5 years, respectively. No opportunistic infections were observed. Conclusions : Oral azathioprine seems to be enough to maintain long‐term remission induced by intravenous ciclosporin in patients with steroid‐refractory ulcerative colitis. The ‘bridging step’ with oral ciclosporin may not be necessary in this subset of patients, although a randomized controlled trial is warranted to confirm this hypothesis.