Cyclosporine A is effective as a rescue therapy for cytomegalovirus reactivated acute severe ulcerative colitis

Background:Cyclosporine A (CyA) is used as a rescue therapy for corticosteroid-refractory acute severe ulcerative colitis (ASUC), but its effectiveness and safety in CMV-reactivated ASUC are unclear. This study aimed to evaluate CyA's efficacy and safety in patients with CMV-reactivated corticosteroid-refractory ASUC.Methods:We retrospectively analyzed 22 patients with corticosteroid-refractory ASUC who were positive for CMV antigen pp65 and received CyA as rescue therapy between 2016 and 2023. We examined patients demographics, corticosteroid dosage, treatment efficacy, safety, and the use of antiviral medications.Results:The median age of patients was 47 years (63% male) with a disease duration of 6 years and a partial Mayo score of 9. At CyA administration, mean serum albumin was 2.5 mg/dL, CRP was 3.8 mg/dL, and the mean prednisolone dosage was 48 mg/day. CyA blood concentrations were maintained between 400-600 ng/mL. After two weeks, 78% of patients showed clinical improvement, and the colectomy rate was 27.3%, consistent with previous reports on CyA rescue therapy for general population of ASUC. Nine patients received ganciclovir (GCV) for CMV treatment, but there was no significant difference in colectomy rates between those who received GCV and those who did not (50% vs. 14%, p = 0.14). No adverse events attributed to CMV infection were observed during treatment.Conclusion: CyA appears to be an effective and safe rescue therapy for CMV-reactivated corticosteroid-refractory ASUC.