Intravenous cyclosporine versus intravenous corticosteroids as single therapy for severe attacks of ulcerative colitis

D’Haens, Geert R.; Lemmens, Liesbeth; Geboes, Karel; Vandeputte, L.; Acker, Fabian; Mortelmans, Luc; Peeters, Marc; Vermeire, Séverine; Penninckx, Freddy; Nevens, Frederik; Hiele, Martin; Rutgeerts, Paul

doi:10.1053/gast.2001.23983

Cited by 378 publications

(232 citation statements)

References 17 publications

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“…As a result, recruitment and expansion of cytotoxic T-lymphocytes and release of other lymphokines are blocked. Therefore, attempting to reduce the inflammatory response in patients with IBD by simultaneously inhibiting multiple pathways may account for the effectiveness of combination regimen [34]. In this regard, CYA, as an apoptotic drug, can be also combined with other agents, such as rapamycin (sirolimus), which also promotes apoptosis of Tlymphocytes, thereby exerting a downregulating effect on the inflammatory response in IBD.…”

Section: Controlled Studies: Brief Results In Active Diseasementioning

confidence: 99%

Immunomodulatory benefits of cyclosporine A in inflammatory bowel disease

Kountouras

Zavos

Chatzopoulos

2004

J Cellular Molecular Medi

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Etiopathogenesis of mucosal inflammation in inflammatory bowel disease remains a complex and enigmatic field; various factors (genetic, environmental and microbial) trigger an event that activates intestinal immune and nonimmune systems culminating in inflammation and tissue injury. Specifically, both innate and adaptive immune systems seem to play important roles in the pathophysiology of this disease. Cyclosporine A represents a macrolide immune modulator with primary inhibitory effects on T helper lymphocyte production of interleukin-2, and other cytokines leading to altered T-lymphocyte and B-lymphocyte function. The diversity of its therapeutic outcome reported in inflammatory bowel disease may be due to the intricate immuno-pathogenic profile of the disease and the variety of the applied dose-dependent courses of therapy. Cyclosporine A exerts additional actions on other components of the inflammatory infiltrate, including neutrophils and mast cells, thereby appearing to be a multi-dynamic therapeutic approach, although with potential drawbacks, that may be applied alone or combined with other immunomodulatory agents in inflammatory bowel disease patients. Because cyclosporine A induces apoptosis of T-lymphocytes responsible for perpetuation of the chronic inflammatory process in the disease with potential tumorigenic effect, it may exert a further inhibitory effect on cancer development in inflammatory bowel disease patients, and can be combined with other relative agents, such as rapamycin, which also promotes T-lymphocyte apoptosis. Therefore, recently established multifactorial action of cyclosporine A in relation to the pathogenesis of the disease can open new horizons for prospective, controlled trials in large cohorts, aiming to emphasize cyclosporine A's potential.

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Section: Controlled Studies: Brief Results In Active Diseasementioning

confidence: 99%

Immunomodulatory benefits of cyclosporine A in inflammatory bowel disease

Kountouras

Zavos

Chatzopoulos

2004

J Cellular Molecular Medi

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“…In a pioneer study, Lichtiger et al (18) showed that endovenous cyclosporine was useful to avoid colectomy in patients with severe UC flares after systemic steroid therapy failure. D'Haens et al (8) concluded that cyclosporine is a valid alternative to intravenous steroids in severe flares. Additionally, controlled studies have shown that cyclosporine may be equivalent to Infliximab in this type of clinical scenario (18) .…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Tacrolimus for Induction of Remission in Patients With Moderate-to-Severe Ulcerative Colitis: A Systematic Review and Meta-Analysis

Lasa

Olivera

2017

Arq. Gastroenterol.

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-Background -There is evidence that shows that calcineurin inhibitors may be useful for the treatment of severe ulcerative colitis. However, evidence regarding the efficacy of tacrolimus for remission induction in this setting is scarce. Objective -To develop a systematic review on the existing evidence regarding the clinical efficacy of tacrolimus for the induction of remission in patients with moderate-to-severe ulcerative colitis. Methods -A literature search was undertaken from 1966 to August 2016 using MEDLINE, Embase, LILACS and the Cochrane Library. The following MeSH terms were used: "Inflammatory Bowel Diseases" or "Ulcerative Colitis" and "Calcineurin Inhibitors" or "Tacrolimus" or "FK506". Studies performed in adult ulcerative colitis patients that evaluated the clinical efficacy of tacrolimus for the induction of remission were considered for revision. A meta-analysis was performed with those included studies that were also placebo-controlled and randomized. Clinical response as well as clinical remission and mucosal healing were evaluated. Results -Overall, 755 references were identified, from which 22 studies were finally included. Only two of them were randomized, placebo-controlled trials. A total of 172 patients were evaluated. A significantly lower risk of failure in clinical response was found for tacrolimus versus placebo ]; moreover, a lower risk of failure in the induction of remission was also found versus placebo ]. Conclusion -Tacrolimus seems to be a valid therapeutic alternative for the induction of remission in patients with moderate-to-severe ulcerative colitis. HEADINGS -Inflammatory bowel diseases. Tacrolimus. Calcineurin inhibitors.

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“…7 The initial response rate to ciclosporin reported in clinical trials is 64-86%, however long-term outcomes are significantly poorer, with observational studies suggesting colectomy rates of 38-88% at up to seven years in initial responders. [8][9][10][11][12][13] In patients who respond to intravenous ciclosporin, therapy is transitioned to oral ciclosporin (5 mg/kg) after 5-7 days. A thiopurine can be started concurrently with oral ciclosporin, with the aim of discontinuing ciclosporin by 3-6 months.…”

Section: Assessing Response To Medical Treatmentmentioning

confidence: 99%

Management of acute severe ulcerative colitis (NICE CG 166)

Macken

Blaker

2015

Clinical Medicine

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Ulcerative colitis (UC) presents as an acute severe flare in 10-15% of new cases and it occurs in 15% of patients with established disease. Acute severe UC can lead to significant morbidity and mortality in predominantly younger patients without other comorbidities. Inpatient hospital admission and a multidisciplinary approach are vital in appropriate and timely management. Important but simple aspects in the initial work-up and treatment of such patients are frequently overlooked during the acute medical take. An overview of the general and more specialist management of this important presentation are discussed herein.

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Intravenous cyclosporine versus intravenous corticosteroids as single therapy for severe attacks of ulcerative colitis

Cited by 378 publications

References 17 publications

Immunomodulatory benefits of cyclosporine A in inflammatory bowel disease

Immunomodulatory benefits of cyclosporine A in inflammatory bowel disease

Efficacy of Tacrolimus for Induction of Remission in Patients With Moderate-to-Severe Ulcerative Colitis: A Systematic Review and Meta-Analysis

Management of acute severe ulcerative colitis (NICE CG 166)

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