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Immunosuppressives boost cyclosporine's effect: ulcerative colitis.

BALTIMORE -- Combination therapy with either 6-mercaptopurine or azathioprine plus cyclosporine may help patients with severe ulcerative colitis avoid colectomies for at least 12 years, Dr. Russell D. Cohen reported at the annual meeting of the American College of Gastroenterology.

Cyclosporine treatment has spared many patients with severe, steroid-refractory ulcerative colitis from undergoing colectomy, but it can result in complications. Dr. Cohen and his colleagues at the University of Chicago examined the factors that determine the success of cyclosporine treatment.

Dr. Cohen originally reported on the University of Chicago Hospitals' review of 42 patients with severe ulcerative colitis at the 1996 annual meeting of the ACG. During 1991-1995, 36 of the 42 patients initially had complete responses to 4 mg/kg of cyclosporine per day, while 6 patients failed the treatment and had colectomies. Ten months later, 10 of the original 36 responders also had colectomies.

At the 2003 annual meeting, Dr. Cohen reported 12 years of follow-up on the 26 patients who at last report still had intact colons. Currently, 18 patients have retained their colons during additional follow-up continuing a median of 6.7 years; the 8 patients who lost their colons had first used cyclosporine a median of 5.4 years prior to their colectomies.

Among the 18 patients with intact colons, 14 (78%) received 6-mercaptopurine (6-MP) or azathioprine for an average of about 5.3 years: 6 patients started 6-MP/azathioprine a median of 21 months prior to beginning cyclosporine therapy, 6 patients began 6-MP/azathioprine during cyclosporine therapy, and 2 patients started 6-MP/azathioprine a median of 7 months after cyclosporine was stopped.

In the patients who had colectomies, 13 (54%) of 24 received 6-MP or azathioprine: 5 patients used the immunosuppressives a median of 9 months before cyclosporine, 3 patients used them during cyclosporine treatment, and 5 began them a median of 21 days after cyclosporine therapy.

An analysis predicted that 43% of all patients would survive without colectomies, but that significantly more patients who also received 6-MP or azathioprine would survive without colectomy after 12 years than those who received cyclosporine alone (54% vs. 17%), said Dr. Cohen of the University of Chicago.

All but eight patients had only one course Of intravenous cyclosporine. Only one of the eight patients who had additional courses of cyclosporine did not have a colectomy.

For all patients, the intravenous cy closporine treatments lasted a mean of 10 days, but 31 patients continued to receive oral cyclosporine for an additional 18 weeks on average.

Overall, 21 of the 42 patients had at least one complication during cyclosporine therapy.

All of the patients recovered, including five patients who had major complications associated with cyclosporine, he commented.

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Title Annotation:Clinical Rounds
Author:Evans, Jeff
Publication:Family Practice News
Geographic Code:1USA
Date:Feb 1, 2004
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