Cytapheresis in patients with severe ulcerative colitis after failure of intravenous corticosteroid: a long-term retrospective cohort study

Abstract

Background/aims: Cytapheresis (CAP) is a novel strategy for ulcerative colitis (UC). However, there is insufficient data on the long-term outcome of UC patients who achieve remission by CAP. This study involved patients with severe UC who refracted to intravenous (iv) corticosteroid.

Methods: Forty-seven UC patients who had received CAP therapy for the first time within 1 year after UC diagnosis were followed for 36 months. One of the inclusion criteria was a clinical activity index (CAI) of >/=7 points at the end of a 2-week iv course of corticosteroid therapy. CAP therapy consisted of ten sessions over 10 weeks.

Results: CAP induced clinical remission (CAI</=4) in 70.2% patients (33/47). The number of submissions for colectomy was higher for severe UC at entry (CAI>/=12, n=25) than for moderately severe UC at entry (7</=CAI<12, p=15; p<0.02). The cumulative rates of avoiding surgery and relapse were 54.5% and 24.2%, respectively, at 36 months in patients who responded to CAP therapy. This was similar to that of iv cyclosporine reported recently.

Conclusions: This study suggest that CAP is an effective therapy in patients who are refractory to conventional medications including iv corticosteroid. Increased remission rates should be expected in refractory patients with moderately severe UC.

Keywords: Corticosteroid; Inflammatory bowel disease; Leukapheresis; Ulcerative colitis.

Fig. 1

A Kaplan-Meier-like plot showing the percentage of patients who avoided colectomy during the 36-month follow-up in this study. Data are based on 33 of 47 patients who initially achieved clinical remission by CAP therapy.

Fig. 2

Percentage of patients who remained relapse free during the 36-months of follow-up after initial CAP-induced clinical remission. Data are based on 33 of 47 patients who initially achieved clinical remission by CAP therapy.