Intravenous tacrolimus is a superior induction therapy for acute severe ulcerative colitis compared to oral tacrolimus.

Abstract

BACKGROUND:

Intravenous corticosteroid is the mainstay for managing acute severe ulcerative colitis, but one-third of patients do not respond to intravenous corticosteroid. Tacrolimus, a salvage therapy before colectomy, is usually orally administered, though its bioavailability is low compared intravenous administration. The efficacy of intravenous tacrolimus has not been widely studied.

AIM:

To determine the efficacy and safety of intravenous tacrolimus for the treatment of acute severe ulcerative colitis.

METHODS:

Eighty-seven hospitalized acute severe ulcerative colitis patients were enrolled for a prospective cohort study between 2009 and 2017. Sixty-five patients received intravenous tacrolimus and 22 received oral tacrolimus. The primary outcome was the achievement of clinical remission within 2 weeks. Relapse and colectomy incidence and adverse events were assessed at 24 weeks.

RESULTS:

Response rates of both treatments exceeded 50% but were not significantly different. The remission rate was higher in intravenous tacrolimus compared with oral tacrolimus. At 24 weeks, oral and intravenous tacrolimus showed similar relapse-free survival rates; however, colectomy-free survival rates were higher in intravenous tacrolimus compared with oral tacrolimus.

CONCLUSIONS:

Patients receiving intravenous tacrolimus achieved superior remission and colectomy-free survival rates compared with patients receiving oral tacrolimus. Safety was similar between the two treatments.

• Authors: Hiromichi Shimizu, Toshimitsu Fujii, Kenji Kinoshita, Ami Kawamoto, Shuji Hibiya, Kento Takenaka, Eiko Saito, Masakazu Nagahori, Kazuo Ohtsuka, Mamoru Watanabe, Ryuichi Okamoto
• Journal: BMC gastroenterology (BMC Gastroenterol) Vol. 21 Issue 1 Pg. 494 (Dec 23 2021) ISSN: 1471-230X [Electronic] England
• PMID: 34949172 (Publication Type: Journal Article)
• Copyright: © 2021. The Author(s).

Chemical References

• Immunosuppressive Agents
• Tacrolimus

Topics

• Administration, Intravenous
• Colitis, Ulcerative (drug therapy)
• Humans
• Immunosuppressive Agents (administration & dosage)
• Induction Chemotherapy
• Prospective Studies
• Remission Induction
• Severity of Illness Index
• Tacrolimus (administration & dosage)
• Treatment Outcome