Journal Article

Cyclosporine Treatment of Steroid-Refractory Ulcerative Colitis During Pregnancy

Lemann, Marc, Marteau, Philippe, Branche, Julien, Seksik, Philippe, Cortot, Antoine, Coffin, Benoît, Bourreille, Arnaud, de Vos, Martine, de Saussure, Philippe, Colombel, Jean-Frédéric

2009

Overview

Cyclosporine is considered a safe and effective treatment of severe steroid-refractory ulcerative colitis (UC). However, few data are available concerning its safety profile in pregnant women. We report here the experience of 5 GETAID centers.MethodsIn a retrospective study data on patients with severe UC treated with cyclosporine during pregnancy were extracted from medical records of consecutive patients treated between 2001 and 2007.ResultsEight patients (median age 30.5 years old) were identified. At the time of flare-up the median duration of pregnancy was 11.5 weeks of gestation (range 4–25). Seven patients had pancolitis. All patients had more than 3 commonly used clinical and biological severity criteria. Three patients had severe endoscopic lesions and 5 patients had not. All patients received intravenous corticosteroids for at least 7 days before introduction of cyclosporine. Two patients received azathioprine during treatment with cyclosporine. No severe infections or other complications due to treatment were observed. Treatment was effective in 7/8 patients. One patient received infliximab due to cyclosporine therapy failure with a good outcome. No colectomy was performed during pregnancy. Seven pregnancies were conducted to term, but 1 in utero death occurred due to maternal absence of S-protein. Two newborns were premature, including 1 case of hypotrophy. No malformations were observed.ConclusionsIn our experience, treatment with cyclosporine for steroid-refractory UC during pregnancy can be considered safe and effective.

• Publisher: Oxford University Press,Wiley Subscription Services, Inc., A Wiley Company
• Subject: Adult / Colitis, Ulcerative - drug therapy / cyclosporine / Cyclosporine - administration & dosage / Cyclosporine - adverse effects / Drug Resistance / Female / Follow-Up Studies / Humans / Immunosuppressive Agents - administration & dosage / Immunosuppressive Agents - adverse effects / Inflammatory bowel disease / Pregnancy / Pregnancy Complications - drug therapy / Pregnancy Outcome / Retrospective Studies / Severity of Illness Index / Steroids / Steroids - therapeutic use / steroid‐refractory / ulcerative colitis