A comparative study of the efficacy of H2 receptor antagonist, prokinetics, and mucosal protective agents in improving cyclosporine-induced gastrointestinal complications

Background: Cyclosporine (CS) has been used successfully for various skin diseases. However, sometimes it is difficult to manage patients due to its adverse events, especially gastrointestinal (GI) discomforts in their clinical practices. Objectives: The aim of this study was to compare the effectiveness of three GI agents for improving CS-induced GI complications. Methods: We performed a prospective study of 60 patients with CS-induced GI complications. The participants were randomly assigned to receive H2 receptor antagonist (H2RA), prokinetics, or mucosal protective agents (MPA), each of 20 patients. Changes in severity of GI symptoms were evaluated by a validated GI Symptom Rating Scale (GSRS) and Dyspepsia Symptom Severity Index (DSSI) at baseline and at 2 and 4 weeks after treatment. Results: All the medications significantly improved GSRS and DSSI after 2- and 4-week of treatment compared with baseline except that 2-week treatment with prokinetics didn’t improve GSRS. There was no significant difference in effectiveness among the medications but GSRS of the 2-week treatment with MPA was better than that of prokinetics (p=0.046). Conclusion: We confirmed CS-induced GI complications were effectively treated with practical GI agents including H2RA, prokinetics, and MPA. However, considering that prokinetics needs more time to have symptomatic relief, H2RA and MPA would be preferred as practical option to maintain patients’ compliance.