Original article
Incidence of Colectomy During Long-term Follow-up After Cyclosporine-Induced Remission of Severe Ulcerative Colitis

https://doi.org/10.1016/j.cgh.2006.04.001Get rights and content

Background & Aims: Cyclosporine (CSA) has been shown to be effective in steroid-refractory ulcerative colitis (UC) and as an alternative to glucocorticosteroids in patients with severe attacks of UC. Our aim was to investigate the long-term efficacy of CSA. Methods: We conducted a retrospective cohort study of all patients admitted to our institution with an attack of UC treated with intravenous CSA between November 1992 and October 2004. Patients who responded to intravenous CSA were switched to Neoral for 3 months. Kaplan–Meier curves were used for survival analysis with quantitative variables compared using a 2-tailed Student t test with qualitative variables and differences compared with a χ2 analysis. Results: A total of 118 (83%) of the 142 patients had an initial response to CSA and avoided colectomy during hospitalization. Of the 118 patients, 64 (54%) required a future colectomy. The rate of colectomy in those already on azathioprine compared with those starting azathioprine concurrently with CSA was 59% vs 31%, respectively (P < .05). Also, 88% of patients already on azathioprine and requiring colectomy underwent surgery within the first year of receiving CSA. Life-table analysis shows that although only 33% of patients require colectomy at 1 year, 88% will require colectomy at 7 years. Conclusions: CSA is an effective short- to medium-term treatment for patients with severe UC but at 7 years, 88% of patients will require a colectomy. Azathioprine-naive patients have better outcomes.

Section snippets

Patients and Treatment Regimen

The medical charts and progress notes of all patients admitted to the Gastroenterology Department of the university hospital of Leuven (Belgium) with a severe attack of UC who were treated with IV CSA between November 1992 and October 2004 were included in the study. This study was an extension of the study performed by Arts et al.10 For patient identification we used the pharmacy records. Before treatment with IV CSA was initiated all patients were treated with IV glucocorticosteroids

Patient Demographics

A total of 142 (65 female, 46%) patients were identified and records for all patients were recovered. The mean age of the patients was 41 years (range, 16–76 y). The mean duration of IV CSA was 9.3 days. The mean duration of oral CSA therapy of the responders to IV CSA was 97 days.

Short-term Response to Intravenous Cyclosporine

A total of 118 of the initial 142 (81%) patients had a response to IV CSA and avoided colectomy during their initial hospitalization. Of these 118 patients, 20 achieved a partial response to CSA and continued to

Discussion

CSA is effective in inducing remission in patients with severe UC. We report an 81% response to IV CSA. Our short-term results that suggest that 48% of patients avoid colectomy at 3 years are similar to other reports.9, 12 Novel data in this study, however, indicate that at 7 years only 12% of patients remain colectomy free. Furthermore, in those patients who have avoided colectomy, 48% are symptomatic at 3 years, with 82% being symptomatic at 7 years. This suggests that a significant majority

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