Effects of cyclosporin A on active Crohn’s disease

Abstract

Seven patients with active Crohn's disease were treated with cyclosporin A orally for 16 weeks. The initial dose was 8 mg/kg/day and the subsequent dose was adjusted to maintain the plasma concentration of cyclosporin A of approximately 200 ng/ml. The mean value of the Crohn's disease activity index before treatment was 194.3 +/- 57.4. It was gradually decreased reaching a nadir at 12 weeks (139.0 +/- 45.6, p less than 0.05) and one enterocutaneous fistula was closed. White blood cell counts, hemoglobin and alpha-2-globulin did not significantly improve during treatment. Cyclosporin A could be indicated when steroids, sulfasalazine or azathioprine are not effective or not tolerated.

Treatment of Perianal Crohn Disease Fistulae

“…There are no controlled trials documenting efficacy of cyclosporine for the treatment of fistulizing Crohn disease. To date, ten case series, with a total of 64 patients, assessing cyclosporine in Crohn fistula have been published [91][92][93][94][95][96][97][98][99][100]. The largest series, by Present and Lichtiger, looked at 16 patients with various types of Crohn fistulae (perianal, rectovaginal, and enterocutaneous) treated with intravenous cyclosporine at a dose of 4 mg/kg/day and observed improvement in 88% with complete fistula closure in 44% [95].…”

The medical treatment of Crohn's perianal fistulas

“…Ciclosporin acts by selectively blocking T‐helper and cytotoxic lymphocytes through the inhibition of the transcription of interleukin‐2. There have been 10 case series reporting the use of intravenous ciclosporin to treat fistulizing Crohn's disease in a total of 64 patients, 84–93 and the overall initial response rate in these studies was 83%(Table 3). Because of its poor oral bioavailability, ciclosporin is usually given as a continuous intravenous infusion at 4 mg/kg per day, with reports of clinical improvement typically within 1 week.…”

Optimización en el tratamiento de formas complicadas de la enfermedad inflamatoria intestinal: Enfermedad de Crohn fistulizante

“…No se han publicado estudios randomizados y controlados designados específicamente para evaluar la eficacia de la ciclosporina en el cierre de las fístulas en los pacientes con EC. Existen ocho estudios no controlados con ciclosporina intravenosa para el tratamiento de la EC fistulizante que no ha respondido a los corticoides, metronidazol o a los antimetabolitos (17)(18)(19)(20)(21)(22)(23)(24). La respuesta inicial completa fue de un 83%.…”