5% vs 56.7%, P = 0.0309). The administration of CSA was discontinued in five cases. Conclusion: 

Our results revealed factors affecting the efficacy of CSA therapy for patients with refractory UC. AZA is an important agent that maintains disease quiescence once one responds to CSA. However, refractory patients despite AZA treatment are more likely to have consequent colectomies. Ulcerative colitis (UC) is characterized by a long-standing chronic course with remissions and exacerbations. Approximately 15% of patients have severe attacks requiring hospitalization at some time during their disease course. These patients are traditionally treated with i.v. corticosteroids, with a response rate of approximately 60%. Patients that do not respond to 5-aminosalicylic acid compounds and corticosteroids are usually considered for colectomies. Few alternative treatments exist for severe UC; immunosuppressive medications (such as azathioprine Everolimus molecular weight [AZA]) have a slow onset of action Torin 1 datasheet and are therefore usually ineffective in acute disease flare-ups. Infliximab is a newly developed biological agent, and factors affecting its efficacy remain to be established.1,2 The induction of cyclosporine A (CSA) for severe, steroid-refractory UC has provided an effective medical alternative to patients previously faced with only surgical options. Uncontrolled

trials3,4 and controlled trials5 established the efficacy of short-term CSA use as “rescue therapy” in severe UC. Lichtiger et al. learn more reported i.v. CSA followed by oral therapy showed an initial response rate of 82% within a mean of 7 days versus 0% in a group that received steroids alone. Quality of life analyses comparing UC patients treated with CSA to those who underwent colectomies have shown that CSA patients consistently score as well as, or better than, their surgical counterparts.6 However, factors affecting CSA remain unclear. In this study, we investigated the efficacy of CSA therapy on refractory UC patients and tried

to define factors responsible for its efficacy. We reviewed medical charts and the recent follow up of 41 patients (26 men and 15 women) who had been administrated CSA for disease flare-ups between December 1999 and March 2009 at the Shiga University of Medical Science Hospital (Table 1). Basically, CSA was administrated in patients resistant to systemic corticosteroids. Cytomegalovirus infections were validated by cytomegalovirus antigenemia (C7-HRP). Ten out of 41 patients received concurrent gancyclovir treatment due to cytomegalovirus infections. The median patient age was 33 years (17–62), and the median disease duration was 4.08 years (19 days to 15 years); the disease type included one attack in four cases, chronic continuous attacks in nine and relapse remitting attacks in 28. The disease extent was total colitis in 28 cases and left-sided colitis in 13.