Commentary: predicting response to ciclosporin in acute severe ulcerative colitis – authors' reply


We thank Drs Peake and Hart for their comments on our article.[1, 2] Our study demonstrated that both the novel calculation formula and the decision-tree predicted with high accuracy the clinical outcome of ciclosporin treatment for acute severe ulcerative colitis as early as on day 3 after starting ciclosporin treatment. However, there may be limitations in the study because it was a retrospective single-centre study. To establish a universal prediction formula for ciclosporin treatment for acute severe ulcerative colitis, prospective multicentre studies should be carried out in the near future.

With regard to the treatment of moderate-to-severe ulcerative colitis, the efficacy of infliximab has been confirmed.[3, 4] There have been some reports of switching from ciclosporin to infliximab and vice versa if one treatment is not effective for acute severe ulcerative colitis.[5-8] However, higher rates of adverse events and mortality due to long-term stronger immunosuppression have warned that administering the sequential therapy should be carefully decided on an individual basis. The establishment of prediction formulae for the efficacy of the individual treatment for acute severe ulcerative colitis would support clinicians to make early clinical decisions and to avoid long-term stronger immunosuppression by giving ineffective medications.


The authors' declarations of personal and financial interests are unchanged from those in the original article.2