Latest news with #Cyclosporin
Medscape
4 days ago
- Health
- Medscape
Cyclosporin: A Viable Option for Severe Ulcerative Colitis
TOPLINE: Cyclosporin was effective in achieving clinical response and remission in adults with severe steroid-refractory ulcerative colitis (UC), enabling more than half of the patients to avoid colectomy. METHODOLOGY: Researchers conducted a retrospective cohort study of 92 patients (mean age, 55 years; 54.4% men) with severe steroid-refractory UC between January 2001 and February 2024 to evaluate the short- and long-term effectiveness and safety of cyclosporin therapy. All patients received intravenous (IV) methylprednisolone (1 mg/kg/d) for 3-7 days as first-line therapy, and owing to unsuccessful treatment, they received IV cyclosporin (median, 3 mg/kg/d) for 5-7 days as second- or third-line rescue treatment. Clinical and endoscopic disease activity was assessed using the Mayo endoscopic subscore and the partial Mayo score (pMayo). The primary outcome was the rate of clinical response and remission to IV cyclosporin therapy. Clinical response was defined as any reduction in the pMayo score from baseline, and clinical remission was defined as a pMayo score of ≤ 2, with a rectal bleeding subscore of zero. In case of clinical response, IV cyclosporin was followed by oral cyclosporin treatment. Other assessments included colectomy-free survival rates and adverse events associated with cyclosporin therapy, with a median follow-up duration of 14 years. TAKEAWAY: Overall, 88% of patients achieved a clinical response, with 23.9% reaching remission after the IV phase of cyclosporin therapy. Among those on oral cyclosporin, 41.9% showed relapse, whereas 40.7% achieved or maintained remission. Cyclosporin therapy was discontinued in 12% of patients owing to insufficient response to IV therapy and in 14.1% due to adverse events. Adverse events associated with cyclosporin were reported in 53.3% of patients. Moreover, 51.9% of patients who showed response to cyclosporin avoided colectomy. At 1, 3, 5, and 14 years after initiating cyclosporin therapy, the probabilities of colectomy-free survival were 74.7%, 62.6%, 57.1%, and 45.6%, respectively. Concomitant immunomodulator use was the sole predictor of clinical remission after treatment with oral cyclosporin (odds ratio [OR], 6.41; P = .002), and hypoalbuminaemia (serum albumin levels < 35 g/L) at the start of therapy was the sole predictor of adverse events (OR, 0.36; P = .03). IN PRACTICE: "[The study] findings suggest that the effectiveness of CsA [cyclosporin] may be enhanced by the concomitant use of IMT [immunomodulator therapy] in active, severe, steroid-refractory UC, without compromising safety," the authors of the study concluded. SOURCE: This study was led by Bernadett Farkas, MD, Department of Internal Medicine, SZTE SZAKK Center for Gastroenterology, University of Szeged, Szeged, Hungary. It was published online on August 08, 2025, in Therapeutic Advances in Gastroenterology. LIMITATIONS: The study's retrospective design may have introduced confounding due to inherent differences in assessments. The sample size was small, and thus, the minimum effective dosage and duration of concomitant immunomodulator therapy were not identified. DISCLOSURES: This study received funding through a grant from the EU's Horizon 2020 research and innovation program, with additional support being received through grants from the National Research, Development and Innovation Office; the János Bolyai Research Grant; and the Géza Hetényi Research Grant from Albert Szent-Györgyi Medical School, University of Szeged to the authors. Two authors reported receiving speakers' honoraria from various pharmaceutical companies. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Perth Now
26-05-2025
- Health
- Perth Now
‘Pure hell': Eczema sufferer's battle with steroid cream
Eczema sufferers are calling for more research into treatments for the painful skin condition, raising the alarm about the long-term use of steroid creams. Most common in children and adolescents, eczema advocates have in recent years increased calls for a national strategy to deal with the condition, which according to the Australian Bureau of Statistics affects 1.6 per cent of all Australians. Eczema Support Australia claims that puts it in the top 10 chronic conditions, affecting 2.8 million people. The condition not only impacts people's skin, but adult sufferers are three times more likely to experience depression and one in five report they've contemplated suicide. Once the mainstay of eczema treatment, steroid creams can lead to a severe and often debilitating condition called topical steroid withdrawal for some people. For Tyrah Spencer, who was born with eczema, her skin flared up in 2020 when her body suddenly stopped responding to the steroid creams she had depended on for most of her life. The 24-year-old said it felt like there was 'no light at the end of the tunnel' when her skin worsened. Tyrah Spencer's skin when the topical steroids she used were no longer working for her eczema. Credit: Supplied Tyrah Spencer's skin when the topical steroids she used were no longer working for her eczema. Credit: Supplied 'Over time, I kept being prescribed stronger steroids. I would have to do these horrible wet wraps where you would put steroid creams on, then put a layer of Dermeze on and then cover myself like a mummy, head to toe in hot bandages,' she said. 'It was eight months of pure hell every single day. My skin would shed top to bottom, I would wake up and my eyes were almost completely closed because they were that swollen. 'I'm a very confident, extroverted person but I completely lost sense of who I was during that experience.' The only relief came when her dermatologist prescribed Cyclosporin, a short-term immunosuppressant, and later Dupixent, an injectable biologic medication. She now takes the medication Rinvoq to calm her eczema. Ms Spencer said she was happy to take medications to ease her symptoms but called for dermatologists and doctors to take a more holistic approach to healing the painful condition. 'My experience wasn't acknowledged. It was just like this medicine is not working let's give you another one and really not addressing the root cause,' she said. 'I would love my dermatologist to take a more holistic approach to my well-being. 'If I'm going to be a regular customer I want to know how to heal rather than just put a bandaid over it.' Melody Livingstone, Australian skin care brand MooGoo chief executive, said topical steroid withdrawal was increasingly being discussed among her customers. 'Sufferers say symptoms include redness, itching, flaking and dryness that just won't seem to go away, even when using the topical steroids,' she said. 'They tell us it can be frustrating, debilitating and disheartening for those experiencing it, as the symptoms can sometimes be even worse than the eczema itself.' Ms Spencer said she was happy to take medications to ease her symptoms but called for dermatologists and doctors to take a more holistic approach to healing the painful condition. Credit: Ross Swanborough / The West Australian Calls for more doctors to be aware of topical steroid withdrawal comes off the back of a recent report revealing more than 88 per cent of UK dermatologists agree withdrawal needs urgent study. But Australian dermatology and doctors groups have urged that topical steroid withdrawal was a very rare reaction and patients suffering from eczema should not be scared to try topical steroids. Dermatologist and Fellow of the Australasian College of Dermatologists Li Chuen Wong said topical steroids were still an effective mainstay treatment for most people with eczema. 'Steroid creams are safe and effective when used until the eczema has resolved, and re-started when there is a flare,' she said. 'If however your condition is severe and not improving with just topical treatments, discuss this with your dermatologist as there are a range of treatments available that are customised to the patient.' Lifeline: 13 11 14
