Background: Intravenous corticosteroid is the mainstay for managing acute severe ulcerative colitis, but one-third of patients do not respond to intravenous corticosteroid. Tacrolimus, a salvage therapy before colectomy, is usually orally administered, though its bioavailability is low compared intravenous administration. The efficacy of intravenous tacrolimus has not been widely studied. Aim: To determine the efficacy and safety of intravenous tacrolimus for the treatment of acute severe ulcerative colitis. Methods: Eighty-seven hospitalized acute severe ulcerative colitis patients were enrolled for a prospective cohort study between 2009 and 2017. Sixty-five patients received intravenous tacrolimus and 22 received oral tacrolimus. The primary outcome was the achievement of clinical remission within 2 weeks. Relapse and colectomy incidence and adverse events were assessed at 24 weeks. Results: Response rates of both treatments exceeded 50% but were not significantly different. The remission rate was higher in intravenous tacrolimus compared with oral tacrolimus. At 24 weeks, oral and intravenous tacrolimus showed similar relapse-free survival rates; however, colectomy-free survival rates were higher in intravenous tacrolimus compared with oral tacrolimus. Conclusions: Patients receiving intravenous tacrolimus achieved superior remission and colectomy-free survival rates compared with patients receiving oral tacrolimus. Safety was similar between the two treatments.
CITATION STYLE
Shimizu, H., Fujii, T., Kinoshita, K., Kawamoto, A., Hibiya, S., Takenaka, K., … Okamoto, R. (2021). Intravenous tacrolimus is a superior induction therapy for acute severe ulcerative colitis compared to oral tacrolimus. BMC Gastroenterology, 21(1). https://doi.org/10.1186/s12876-021-02043-6
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