Infl iximab versus ciclosporin in severe ulcerative colitis

1fi rst reported effi cacy of intravenous corticosteroids for severe ulcerative colitis. However, if steroids fail then the likelihood of colectomy is high and few medical options are available. Ciclosporin and infl iximab have become the main rescue drugs for severe steroid-refractory ulcerative colitis, but their relative effi cacy is unknown. The effi cacy of intravenous ciclosporin in severe ulcerative colitis was fi rst shown in an uncontrolled pilot study. 2 Subsequently, a placebo-controlled trial 3 of 20 patients showed that a 4 mg/kg dose was effi cacious in steroid-refractory cases. This study was stopped early because of greater-than-expected initial benefi cial eff ects of ciclosporin, and thus did not provide an accurate estimate for the drug’s effi cacy. 4

[1]  S. Targan,et al.  Anti-CD3 antibody visilizumab is not effective in patients with intravenous corticosteroid-refractory ulcerative colitis , 2010, Gut.

[2]  A. Kornbluth,et al.  Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee , 2010, The American Journal of Gastroenterology.

[3]  Paul Rutgeerts,et al.  Infliximab for induction and maintenance therapy for ulcerative colitis. , 2005, The New England journal of medicine.

[4]  Gordon H Guyatt,et al.  Randomized trials stopped early for benefit: a systematic review. , 2005, JAMA.

[5]  Å. Danielsson,et al.  Infliximab as rescue therapy in severe to moderately severe ulcerative colitis: a randomized, placebo-controlled study. , 2005, Gastroenterology.

[6]  P. Rutgeerts,et al.  Long-term Outcome of Treatment with Intravenous Cyclosporin in Patients With Severe Ulcerative Colitis , 2004, Inflammatory bowel diseases.

[7]  P. Rutgeerts,et al.  Randomized, double-blind comparison of 4 mg/kg versus 2 mg/kg intravenous cyclosporine in severe ulcerative colitis. , 2003, Gastroenterology.

[8]  S. Targan,et al.  Infliximab in the Treatment of Severe, Steroid-Refractory Ulcerative Colitis: A Pilot Study , 2001, Inflammatory bowel diseases.

[9]  A. Kornbluth,et al.  Ulcerative colitis practice guidelines in adults , 1997 .

[10]  S. Hanauer,et al.  Cyclosporine in severe ulcerative colitis refractory to steroid therapy. , 1994, The New England journal of medicine.

[11]  D. Present,et al.  Preliminary report: cyclosporin in treatment of severe active ulcerative colitis , 1990, The Lancet.

[12]  D. Jewell,et al.  Intensive intravenous regimen for severe attacks of ulcerative colitis. , 1974, Lancet.