Cyclosporin for refractory ulcerative colitis

Intravenous cyclosporin (with or without continued intravenous corticosteroids) is effective in 50-80% of patients with severe ulcerative colitis. An initial dose of 2 mg/kg/day intravenous cyclosporin appears to be as effective as 4 mg/kg/day and is thus preferred from the standpoint of safety. Long term response rates following short term treatment with intravenous cyclosporin in controlled trials ranged from 45% (without azathioprine maintenance) to 78% (with azathioprine). There is a small risk of opportunistic infection and death (1-2%) during combined cyclosporin, corticosteroid, and azathioprine therapy, but lower doses of cyclosporin may improve the safety profile. Toxicity may be reduced at a dose of 2 mg/kg/day intravenous cyclosporin.