گزارش درمان شش مورد کولیت اولسروز مقاوم به درمان استاندارد با سیکلوسپرین

Background and purpose: Treatment of refractory ulcerative colitis (ÜÇ) is a problem in the intestinal tract diseases. Different researches have shown that intravenous administration of cyclosporine before surgical operation can be effective. But less is known about the oral administration of cyclosporine given at the onset of the treatment of refractory ÜÇ. Ïn this study effectiveness and side effects of cyclosporine have been evaluated in the severe case of ÜÇ. Materials and Methods: Four cases of ÜÇ. at severe attack, conformed on the basis of Truelove and wilk criteria were found resistant to steroids, and two patients were dependent to steroids whose disease was not controlled completely and were under our investigation. Two patients received intravenous cyclosporine 4 mg/kg daily for two days and followed by low does of (≤ 5mg/kg daily) oral administration of cyclosporine. The same low doses of oral cyclosporine were administered in four patients at the onset of treatment. Mean duration of treatment was 15.5 weeks. Response to treatment was evaluated on the basis of frequency of defecation, rectorhalgia and colonoscopic appearance. Blood level of cyclosporine in the, 9, 4, 6, 8, 10, 14 and 18 weeks was measured. Âll the patients simultaneously received corticosteroides sulfasulazin 5-ÂSÂ, and patients received Âzathioprine (6MP). Results: The severiarity of disease was decreased after intravenous administration of cyclosporine within 2 months, but one of all six patients was recovered after the administration of low dose of oral cyclosporine. Ôn the basis of statistical analysis there was no apparent recovery in the mean score of variants. Finally after 18 weeks three patients were colectomy, and there was no significant response in 2 patients. Ïn four patients there was side effects of sinusitis, gum hyperplasy severe reduction of libido and increase in keratinin in one patient, tremor was observed in 2 patients. Çonclusion: Ïn our limited experience,low doses of cyclosporine in controlled standard refractory ÜÇ was not effective and was followed by side effects.