Cyclosporine A for induction of remission in severe ulcerative colitis

Shibolet, Oren; Regushevskaya, Elena; Brezis, Mayer; Soares‐Weiser, Karla

doi:10.1002/14651858.cd004277.pub2

Cited by 130 publications

(81 citation statements)

References 36 publications

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“…36 Pediatric cyclosporine data come from 8 retrospective case series (total of 94 children) in which the rate and adverse events were similar to those reported in adults. 7,37 The pooled short-term response was 81%, but only 39% avoided colectomy in the long-term.…”

Section: Figurementioning

confidence: 84%

Management of Acute Severe Colitis in Children With Ulcerative Colitis in the Biologics Era

et al. 2016

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BACKGROUND AND OBJECTIVE: Approximately one-third of children with ulcerative colitis will experience at least 1 attack of acute severe colitis (ASC) before 15 years of age. Severe disease can be defined in children when Pediatric Ulcerative Colitis Activity Index is >65 and/or ≥6 bloody stools per day, and/or 1 of the following: tachycardia, fever, anemia, and elevated erythrocyte sedimentation rate with or without systemic toxicity. Our aim was to provide practical suggestions on the management of ASC in children. The goal of medical therapy is to avoid colectomy while preventing complications of disease, side effects of medications, and mortality. METHODS: A systematic search was carried out through Medline via PubMed to identify all articles published in English to date, based on the following keywords “ulcerative colitis,” “pediatric ulcerative colitis,” “biological therapy,” and “acute severe colitis.” Multidisciplinary clinical evaluation is recommended to identify early nonresponders to conventional treatment with intravenous corticosteroids, and to start, if indicated, second-line therapy or “rescue therapy,” such as calcineurin inhibitors (cyclosporine, tacrolimus) and anti–tumor necrosis factor molecules (infliximab). RESULTS: Pediatric Ulcerative Colitis Activity Index is a valid predictive tool that can guide clinicians in evaluating response to therapy. Surgery should be considered in the case of complications or rapid clinical deterioration during medical treatment. CONCLUSIONS: Several pitfalls may be present in the management of ASC, and a correct clinical and therapeutic approach is recommended to reduce surgical risk.

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Section: Figurementioning

confidence: 84%

Management of Acute Severe Colitis in Children With Ulcerative Colitis in the Biologics Era

et al. 2016

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“…Whilst the retrospective nature of our data analysis may not have detected mild adverse events associated with infliximab our data are consistent with published studies which demonstrate an adverse side effect profile in UC similar to that seen in Crohn's disease [29] . This may favour the use of infliximab over cyclosporine as a rescue therapy, as there has been reluctance in some countries to use cyclosporine, even at 2 mg/kg, due to the risks of hypertension, seizures and nephrotoxicity [30] .…”

Section: Discussionmentioning

confidence: 99%

The use of infliximab in the prevention and delay of colectomy in severe steroid dependant and refractory ulcerative colitis

Willert¹,

Lawrance²

2008

WJG

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AIM: To determine if infliximab can prevent or delay surgery in refractory ulcerative colitis (UC). METHODS:UC patients who failed to have their disease controlled with conventional therapies and were to undergo colectomy if infliximab failed to induce a clinical improvement were reviewed. Patients were primarily treated with a single 5 mg/kg infliximab dose. The Colitis Activity Index (CAI) was used to determine response and remission. Data of 8 wk response and colectomy rates at 6 mo and 12 mo were collected. RESULTS:Fifteen patients were included, 7 with UC unresponsive or intolerant to Ⅳ hydrocortisone, and 8 with active disease despite oral steroids (all but one with therapeutic dosage and duration of immunomodulation). All the Ⅳ hydrocortisone-resistant/intolerant patients had been on azathioprine/6-MP < 8 wk. At 8 wk, infliximab induced a response in 86.7% (13/15) with 40% in remission (6/15). Within 6 mo of treatment 26.7% (4/15) had undergone colectomy and surgery was avoided in 46.6% (7/15) at 12 mo. The colectomy rate at 12 mo in those on immunomodulatory therapy < 8 wk at time of infliximab was 12.5% (1/8) compared with 100% (7/7) in patients who were on long-term maintenance immunomodulators (P < 0.02). CONCLUSION:Infliximab prevented colectomy due to active disease in immunomodulatory-naïve, refractory UC patients comparable to the use of Cyclosporine. In patients, however, on effective dosage and duration of immunomodulation at time of infliximab therapy colectomy was not avoided.

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“…The success rate of reinduction with intravenous cyclosporine was obtained from two studies utilized in a systematic review published in Cochrane, and the value is 73% (26) . In these patients, maintenance was performed with oral cyclosporine (8 mg/kg/day) during the first three months along with azathioprine, the latter being maintained in the case the patient remains in remission.…”

Section: Failure In Remissionmentioning

confidence: 99%

Decision Tree Construction and Cost-Effectiveness Analysis of Treatment of Ulcerative Colitis With Pentasa®mesalazine 2 G Sachet

Nishikawa

Paladini

Delfini

et al. 2013

Arq. Gastroenterol.

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-Context -Unspecified Ulcerative Rectocolitis is a chronic disease that affects between 0.5 and 24.5/10 5 inhabitants in the world. National and international clinical guidelines recommend the use of aminosalicylates (including mesalazine) as first-line therapy for induction of remission of unspecified ulcerative rectocolitis, and recommend the maintenance of these agents after remission is achieved. However, multiple daily doses required for the maintenance of disease remission compromise compliance with treatment, which is very low (between 45% and 65%). Use of mesalazina in granules (2 g sachet) once daily -Pentasa ® sachets 2 g -can enhance treatment adherence, reflecting in an improvement in patients' outcomes. Objective -To evaluate the evidence on the use of mesalazine for the maintenance of remission in patients with unspecified ulcerative rectocolitis and its effectiveness when taken once versus more than once a day. From an economic standpoint, to analyze the impact of the adoption of this dosage in Brazil's public health system, considering patients' adherence to treatment. Methods -A decision tree was developed based on the Clinical Protocol and Therapeutic Guidelines for Ulcerative Colitis, published by the Ministry of Health in the lobby SAS/MS n° 861 of November 4 th, 2002 and on the algorithms published by the Associação Brasileira de Colite Ulcerativa e Doença de Crohn, aiming to get the cost-effectiveness of mesalazine once daily in granules compared with mesalazine twice daily in tablets. ResultsThe use of mesalazine increases the chances of remission induction and maintenance when compared to placebo, and higher doses are associated with greater chance of success without increasing the risk of adverse events. Conclusion -The use of a single daily dose in the maintenance of remission is effective and related to higher patient compliance when compared to the multiple daily dose regimens, with lower costs.

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Cyclosporine A for induction of remission in severe ulcerative colitis

Cited by 130 publications

References 36 publications

Management of Acute Severe Colitis in Children With Ulcerative Colitis in the Biologics Era

Management of Acute Severe Colitis in Children With Ulcerative Colitis in the Biologics Era

The use of infliximab in the prevention and delay of colectomy in severe steroid dependant and refractory ulcerative colitis

Decision Tree Construction and Cost-Effectiveness Analysis of Treatment of Ulcerative Colitis With Pentasa®mesalazine 2 G Sachet

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