Azathioprine is essential following cyclosporine for patients with steroid-refractory ulcerative colitis

Nobuyuki Miyake, Takafumi Ando, Kazuhiro Ishiguro, Osamu Maeda, Osamu Watanabe, Yutaka Hirayama, Keiko Maeda, Kazuhiro Morise, Masanobu Matsushita, Kazuhiro Furukawa, Kohei Funasaka, Masanao Nakamura, Ryoji Miyahara, Naoki Omiya, Hidemi Goto

Research output: Contribution to journalArticle

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Abstract

AIM: To evaluate long-term prognosis following cyclosporine treatment by examining the rate of surgery avoidance among cyclosporine responders. METHODS: We retrospectively reviewed clinical records for 29 patients diagnosed with severe steroid-refractory ulcerative colitis in our hospital from August 1997 to August 2008 and treated with cyclosporine by continuous intravenous infusion. All patients were treated with intravenous corticosteroids for more than 5 d prior to cyclosporine therapy. Administration was continued for up to 21 d under serum monitoring to maintain cyclosporine levels between 400 and 600 ng/mL. Clinical activity was assessed before and after cyclosporine therapy using the clinical activity index score, with a reduction of ≥ 5 considered to indicate a response. Among responders, we defined cases not requiring surgery for more than 5 years as exhibiting long-term efficacy of cyclosporine. Factors considered to be possibly predictive of long-term efficacy of cyclosporine were sex, age, disease duration, clinical activity index score, C-reactive protein level, hemoglobin level, disease extent, endoscopic findings, and clinical course. RESULTS: Cyclosporine was not discontinued due to side effects in any patient. Nineteen (65.5%) of 29 patients were considered responders. A statistically significant (P = 0.004) inverse association was observed between an endoscopic finding of "mucosal bleeding" and responsive cases. Fifteen (9 males, 6 females) of these 19 patients were followed for 5 years or more, of whom 9 (60%) exhibited long-term efficacy of cyclosporine. Of the 10 non-responders, 9 (90%) underwent surgery within 6 mo of cyclosporine therapy. None of the following factors had a significant impact on the long-term efficacy of cyclosporine: sex, age, duration of disease, clinical activity index score, C-reactive protein level, hemoglobin level, extent of disease, endoscopic findings, or clinical course. In contrast, a significant association was observed for maintenance therapy with azathioprine after cyclosporine therapy (P = 0.0014). CONCLUSION: Maintenance therapy with azathioprine might improve the long-term efficacy of continuously infused cyclosporine for severe steroid-refractory ulcerative colitis patients.

Original languageEnglish
Pages (from-to)254-261
Number of pages8
JournalWorld Journal of Gastroenterology
Volume21
Issue number1
DOIs
Publication statusPublished - 07-01-2015

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Azathioprine
Ulcerative Colitis
Cyclosporine
Steroids
C-Reactive Protein
Therapeutics
Hemoglobins
Intravenous Infusions
Adrenal Cortex Hormones

All Science Journal Classification (ASJC) codes

  • Gastroenterology

Cite this

Miyake, Nobuyuki ; Ando, Takafumi ; Ishiguro, Kazuhiro ; Maeda, Osamu ; Watanabe, Osamu ; Hirayama, Yutaka ; Maeda, Keiko ; Morise, Kazuhiro ; Matsushita, Masanobu ; Furukawa, Kazuhiro ; Funasaka, Kohei ; Nakamura, Masanao ; Miyahara, Ryoji ; Omiya, Naoki ; Goto, Hidemi. / Azathioprine is essential following cyclosporine for patients with steroid-refractory ulcerative colitis. In: World Journal of Gastroenterology. 2015 ; Vol. 21, No. 1. pp. 254-261.
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abstract = "AIM: To evaluate long-term prognosis following cyclosporine treatment by examining the rate of surgery avoidance among cyclosporine responders. METHODS: We retrospectively reviewed clinical records for 29 patients diagnosed with severe steroid-refractory ulcerative colitis in our hospital from August 1997 to August 2008 and treated with cyclosporine by continuous intravenous infusion. All patients were treated with intravenous corticosteroids for more than 5 d prior to cyclosporine therapy. Administration was continued for up to 21 d under serum monitoring to maintain cyclosporine levels between 400 and 600 ng/mL. Clinical activity was assessed before and after cyclosporine therapy using the clinical activity index score, with a reduction of ≥ 5 considered to indicate a response. Among responders, we defined cases not requiring surgery for more than 5 years as exhibiting long-term efficacy of cyclosporine. Factors considered to be possibly predictive of long-term efficacy of cyclosporine were sex, age, disease duration, clinical activity index score, C-reactive protein level, hemoglobin level, disease extent, endoscopic findings, and clinical course. RESULTS: Cyclosporine was not discontinued due to side effects in any patient. Nineteen (65.5{\%}) of 29 patients were considered responders. A statistically significant (P = 0.004) inverse association was observed between an endoscopic finding of {"}mucosal bleeding{"} and responsive cases. Fifteen (9 males, 6 females) of these 19 patients were followed for 5 years or more, of whom 9 (60{\%}) exhibited long-term efficacy of cyclosporine. Of the 10 non-responders, 9 (90{\%}) underwent surgery within 6 mo of cyclosporine therapy. None of the following factors had a significant impact on the long-term efficacy of cyclosporine: sex, age, duration of disease, clinical activity index score, C-reactive protein level, hemoglobin level, extent of disease, endoscopic findings, or clinical course. In contrast, a significant association was observed for maintenance therapy with azathioprine after cyclosporine therapy (P = 0.0014). CONCLUSION: Maintenance therapy with azathioprine might improve the long-term efficacy of continuously infused cyclosporine for severe steroid-refractory ulcerative colitis patients.",
author = "Nobuyuki Miyake and Takafumi Ando and Kazuhiro Ishiguro and Osamu Maeda and Osamu Watanabe and Yutaka Hirayama and Keiko Maeda and Kazuhiro Morise and Masanobu Matsushita and Kazuhiro Furukawa and Kohei Funasaka and Masanao Nakamura and Ryoji Miyahara and Naoki Omiya and Hidemi Goto",
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Miyake, N, Ando, T, Ishiguro, K, Maeda, O, Watanabe, O, Hirayama, Y, Maeda, K, Morise, K, Matsushita, M, Furukawa, K, Funasaka, K, Nakamura, M, Miyahara, R, Omiya, N & Goto, H 2015, 'Azathioprine is essential following cyclosporine for patients with steroid-refractory ulcerative colitis', World Journal of Gastroenterology, vol. 21, no. 1, pp. 254-261. https://doi.org/10.3748/wjg.v21.i1.254

Azathioprine is essential following cyclosporine for patients with steroid-refractory ulcerative colitis. / Miyake, Nobuyuki; Ando, Takafumi; Ishiguro, Kazuhiro; Maeda, Osamu; Watanabe, Osamu; Hirayama, Yutaka; Maeda, Keiko; Morise, Kazuhiro; Matsushita, Masanobu; Furukawa, Kazuhiro; Funasaka, Kohei; Nakamura, Masanao; Miyahara, Ryoji; Omiya, Naoki; Goto, Hidemi.

In: World Journal of Gastroenterology, Vol. 21, No. 1, 07.01.2015, p. 254-261.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Azathioprine is essential following cyclosporine for patients with steroid-refractory ulcerative colitis

AU - Miyake, Nobuyuki

AU - Ando, Takafumi

AU - Ishiguro, Kazuhiro

AU - Maeda, Osamu

AU - Watanabe, Osamu

AU - Hirayama, Yutaka

AU - Maeda, Keiko

AU - Morise, Kazuhiro

AU - Matsushita, Masanobu

AU - Furukawa, Kazuhiro

AU - Funasaka, Kohei

AU - Nakamura, Masanao

AU - Miyahara, Ryoji

AU - Omiya, Naoki

AU - Goto, Hidemi

PY - 2015/1/7

Y1 - 2015/1/7

N2 - AIM: To evaluate long-term prognosis following cyclosporine treatment by examining the rate of surgery avoidance among cyclosporine responders. METHODS: We retrospectively reviewed clinical records for 29 patients diagnosed with severe steroid-refractory ulcerative colitis in our hospital from August 1997 to August 2008 and treated with cyclosporine by continuous intravenous infusion. All patients were treated with intravenous corticosteroids for more than 5 d prior to cyclosporine therapy. Administration was continued for up to 21 d under serum monitoring to maintain cyclosporine levels between 400 and 600 ng/mL. Clinical activity was assessed before and after cyclosporine therapy using the clinical activity index score, with a reduction of ≥ 5 considered to indicate a response. Among responders, we defined cases not requiring surgery for more than 5 years as exhibiting long-term efficacy of cyclosporine. Factors considered to be possibly predictive of long-term efficacy of cyclosporine were sex, age, disease duration, clinical activity index score, C-reactive protein level, hemoglobin level, disease extent, endoscopic findings, and clinical course. RESULTS: Cyclosporine was not discontinued due to side effects in any patient. Nineteen (65.5%) of 29 patients were considered responders. A statistically significant (P = 0.004) inverse association was observed between an endoscopic finding of "mucosal bleeding" and responsive cases. Fifteen (9 males, 6 females) of these 19 patients were followed for 5 years or more, of whom 9 (60%) exhibited long-term efficacy of cyclosporine. Of the 10 non-responders, 9 (90%) underwent surgery within 6 mo of cyclosporine therapy. None of the following factors had a significant impact on the long-term efficacy of cyclosporine: sex, age, duration of disease, clinical activity index score, C-reactive protein level, hemoglobin level, extent of disease, endoscopic findings, or clinical course. In contrast, a significant association was observed for maintenance therapy with azathioprine after cyclosporine therapy (P = 0.0014). CONCLUSION: Maintenance therapy with azathioprine might improve the long-term efficacy of continuously infused cyclosporine for severe steroid-refractory ulcerative colitis patients.

AB - AIM: To evaluate long-term prognosis following cyclosporine treatment by examining the rate of surgery avoidance among cyclosporine responders. METHODS: We retrospectively reviewed clinical records for 29 patients diagnosed with severe steroid-refractory ulcerative colitis in our hospital from August 1997 to August 2008 and treated with cyclosporine by continuous intravenous infusion. All patients were treated with intravenous corticosteroids for more than 5 d prior to cyclosporine therapy. Administration was continued for up to 21 d under serum monitoring to maintain cyclosporine levels between 400 and 600 ng/mL. Clinical activity was assessed before and after cyclosporine therapy using the clinical activity index score, with a reduction of ≥ 5 considered to indicate a response. Among responders, we defined cases not requiring surgery for more than 5 years as exhibiting long-term efficacy of cyclosporine. Factors considered to be possibly predictive of long-term efficacy of cyclosporine were sex, age, disease duration, clinical activity index score, C-reactive protein level, hemoglobin level, disease extent, endoscopic findings, and clinical course. RESULTS: Cyclosporine was not discontinued due to side effects in any patient. Nineteen (65.5%) of 29 patients were considered responders. A statistically significant (P = 0.004) inverse association was observed between an endoscopic finding of "mucosal bleeding" and responsive cases. Fifteen (9 males, 6 females) of these 19 patients were followed for 5 years or more, of whom 9 (60%) exhibited long-term efficacy of cyclosporine. Of the 10 non-responders, 9 (90%) underwent surgery within 6 mo of cyclosporine therapy. None of the following factors had a significant impact on the long-term efficacy of cyclosporine: sex, age, duration of disease, clinical activity index score, C-reactive protein level, hemoglobin level, extent of disease, endoscopic findings, or clinical course. In contrast, a significant association was observed for maintenance therapy with azathioprine after cyclosporine therapy (P = 0.0014). CONCLUSION: Maintenance therapy with azathioprine might improve the long-term efficacy of continuously infused cyclosporine for severe steroid-refractory ulcerative colitis patients.

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