A dosage of 4 mg/kg/day intravenous
cyclosporine as an adjunct to high-dosage
hydrocortisone has been recommended to avoid
colectomy in acute
steroid-resistant
ulcerative colitis. In treating eight such patients, four of whom presented with
toxic megacolon, we immediately tapered the
steroid dosage and infused a lower dosage of only 2 mg/kg
cyclosporine for 15 days to fit a therapeutic range of 60-240 ng/ml, as previously designed for a kidney transplant program. Seven of the eight (87.5%), including three with
megacolon, went into remission and started the chronic phase of treatment; the eighth patient underwent
colectomy. Of the seven, one died on day 3 of the chronic phase because of
pulmonary embolism while in clinical remission, and another discontinued treatment. The other five (62.5%) remain in remission on 6 mg/kg oral
cyclosporine, or have already switched from
cyclosporine to
azathioprine. Two episodes of reversible nephrotoxicity appeared in the chronic phase only. These results emphasize the efficacy and safety of
cyclosporine in acute
ulcerative colitis, but there is still a need for further dose-response and
drug association relationship studies.