Both authors contributed equally to this work.This article is dedicated to Jörg Emmrich.
Short-term efficacy of tacrolimus in steroid-refractory ulcerative colitis – experience in 130 patients
Article first published online: 5 NOV 2012
© 2012 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 37, Issue 1, pages 129–136, January 2013
How to Cite
Schmidt, K. J., Herrlinger, K. R., Emmrich, J., Barthel, D., Koc, H., Lehnert, H., Stange, E. F., Fellermann, K. and Büning, J. (2013), Short-term efficacy of tacrolimus in steroid-refractory ulcerative colitis – experience in 130 patients. Alimentary Pharmacology & Therapeutics, 37: 129–136. doi: 10.1111/apt.12118
- Issue published online: 4 DEC 2012
- Article first published online: 5 NOV 2012
- Manuscript Accepted: 9 OCT 2012
- Manuscript Revised: 8 OCT 2012
- Manuscript Revised: 16 JUN 2012
- Manuscript Received: 15 MAY 2012
Steroid-refractory ulcerative colitis (UC) remains a challenging condition warranting surgery upon failure of pharmacological treatment. Calcineurin inhibitors or infliximab are alternatives in this situation. Data on the efficacy and safety of tacrolimus in this setting are limited.
To study the short-term efficacy and safety of tacrolimus in moderate-to-severe steroid-refractory UC. The role of thiopurines in this situation and predictors of colectomy were evaluated.
In three centers, all charts from tacrolimus-treated patients with steroid-refractory UC were reviewed. Efficacy was assessed by colectomy-free survival and clinical remission at 3 months.
We identified 130 patients with pancolitis in 75 (59%), left-sided disease in 35 (27%) and proctitis in 18 patients (14%) (disease localisation not obtainable in two patients). The median age was 40 (range: 18–81). Clinical activity according to the median Lichtiger score decreased from 13 (range: 4–17) at baseline to 3 (0–14) at week 12. Eighteen patients underwent colectomy within the first 3 months of treatment with tacrolimus (14%). Clinical remission was achieved in 94 patients (72%) in this period. Thiopurines given in parallel to tacrolimus tended to limit colectomy and significantly increased remission (P = 0.002) in the short-term. No other predictors of colectomy or remission were identified. Side effects were noticed in 53% of patients and no severe events occurred.
This large survey confirms the efficacy and safety of tacrolimus in patients with steroid-refractory ulcerative colitis.