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Aliment Pharmacol Ther. 2003 May 15;17(10):1273-81.

Rescue therapy with tacrolimus is effective in patients with severe and refractory inflammatory bowel disease.

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1
Charité Medical Center-Virchow Hospital, Medical School of the Humboldt University of Berlin, Department of Medicine, Division of Hepatology and Gastroenterology, Berlin, Germany.

Abstract

BACKGROUND:

Oral tacrolimus, approved for the prophylaxis of organ rejection in liver or kidney transplants, has been reported to be effective in anecdotal cases of refractory inflammatory bowel disease.

AIM:

To evaluate the usefulness of low-dose oral tacrolimus in refractory inflammatory bowel disease.

METHODS:

Thirty-one adult Caucasian patients with steroid-dependent (n = 15) or steroid-refractory (n = 16) inflammatory bowel disease (Crohn's disease, n = 6; ulcerative colitis, n = 23; pouchitis, n = 2) were enrolled. Tacrolimus (0.1 mg/kg body weight per day) was administered orally in 30 patients and initially intravenously in one patient (0.01 mg/kg body weight per day), aiming for serum trough levels of 4-6 ng/mL. The median treatment duration was 12 months (range, 1-137 months).

RESULTS:

Twenty-eight patients (90.3%) experienced a clinical and laboratory response and 20 (64.5%) went into remission. One ulcerative colitis patient and two Crohn's disease patients did not improve. Three ulcerative colitis patients (9.7%) were colectomized at 1, 12 and 24 months after tacrolimus initiation. In 19 of 23 patients (82.6%) taking steroids, steroids were reduced or discontinued. Side-effects included a temporary rise of creatinine (n = 3, 9.7%), tremor or paraesthesias (n = 3, 9.7%), hyperkalaemia (n = 1, 3.2%), hypertension (n = 1, 3.2%) and an opportunistic infection (n = 1, 3.2%).

CONCLUSION:

Oral tacrolimus is safe and effective in refractory inflammatory bowel disease.

[Indexed for MEDLINE]
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