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Journal of Crohn's and Colitis: 9 (5)

Editor-in-Chief

Laurence J. Egan, Ireland

Associate Editors

Maria T. Abreu, USAShomron Ben-Horin, IsraelSilvio Danese, ItalyPeter Lakatos, HungaryMiles Parkes, UKGijs van den Brink, NLSéverine Vermeire, Belgium

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Mucosal healing with oral tacrolimus is associated with favorable medium- and long-term prognosis in steroid-refractory/dependent ulcerative colitis patients

Jun Miyoshi , Katsuyoshi Matsuoka , Nagamu Inoue , Tadakazu Hisamatsu , Riko Ichikawa , Tomoharu Yajima , Susumu Okamoto , Makoto Naganuma , Toshiro Sato , Takanori Kanai , Haruhiko Ogata , Yasushi Iwao , Toshifumi Hibi
DOI: http://dx.doi.org/10.1016/j.crohns.2013.04.018 e609-e614 First published online: 1 December 2013

Abstract

BackgroundOral administration of tacrolimus is an effective remission induction therapy for steroid-refractory/dependent ulcerative colitis (UC).

AimThis study aimed to evaluate the short- as well as medium- and long-term effectiveness of tacrolimus therapy.

MethodsThe medical records of 51 patients treated with tacrolimus for UC at our hospital between July 2009 and December 2011 were reviewed retrospectively. Clinical remission and improvement were defined as a Lichtiger score of 4 or less and as a Lichtiger score of ≤ 10 and a reduction in the score of ≥ 3 compared with the baseline score, respectively. Endoscopic findings were evaluated based on the endoscopic activity index and Mayo endoscopic score.

ResultsThe clinical effectiveness combining clinical remission and improvement was observed in 62.7% of the patients at 3 months. Thirty-six patients underwent colonoscopy at 3 months, and 12 (33.3%) and 10 patients (27.8%) showed Mayo endoscopic scores of 0 and 1, respectively. On Kaplan–Meier analysis, the overall percentage of event-free survivors, who did not require colectomy nor switching to other induction therapy such as infliximab, was 73.0% at 6 months, 49.9% at 1 year, and 37.8% at 2 years. Patients with a Mayo endoscopic score of 0–1 at 3 months showed significantly better medium- and long-term prognosis than those with a score of 2–3 (p < 0.01). All adverse events, including infections in 2 patients, were reversible.

ConclusionsTacrolimus therapy was effective for inducing clinical and endoscopic remission of steroid-refractory/dependent UC. Endoscopic improvement was associated with favorable medium- and long-term prognosis.

Keywords
  • Ulcerative colitis
  • Tacrolimus
  • Mucosal healing
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