Long-interval Cytapheresis as a Novel Therapeutic Strategy Leading to Dosage Reduction and Discontinuation of Steroids in Steroid-dependent Ulcerative Colitis

Abstract

Objective This study was performed to confirm the efficacy of long-interval cytapheresis on steroid-dependent ulcerative colitis (UC). Methods To discontinue steroids in patients with steroid-dependent UC, we previously designed a novel regimen of cytapheresis (CAP), which we termed "long-interval cytapheresis (LI-CAP)", in which CAP was performed as one session every two or three weeks and continued during the whole period of tapering steroid dosage. In this study, we performed LI-CAP therapy 20 times (11 male and 9 female; mean age 41.8 years) between April 2010 and April 2015 for 14 patients with steroid-dependent UC. We evaluated the effectiveness of LI-CAP by examining the improvement in Lichtiger's clinical activity index (CAI), the rate of clinical remission, and the rate of steroid discontinuation. We further examined the rate of sustained steroid-free clinical remission at 6 and 12 months after LI-CAP in patients who successfully discontinued steroid-use after LI-CAP. The primary endpoint was the rate of discontinuation of steroids after LI-CAP. Results The mean CAI score before LI-CAP (7.550) significantly decreased to 1.65 after LI-CAP (p<0.0001). The rate of clinical remission after LI-CAP was 80%. The rate of steroid discontinuation after LI-CAP was 60.0%. The mean dose of daily prednisolone was significantly decreased after LI-CAP (2.30 mg) compared with that before therapy (17.30 mg) (p=0.0003). The rate of sustained steroid-free clinical remission after LI-CAP was 66.7% at 6 months and 66.7% at 12 months. Conclusion We confirmed that LI-CAP has therapeutic effects on reducing the dosage and discontinuing steroids in patients with steroid-dependent UC.

Keywords: cytapheresis; granulocyte and monocyte adsorptive apheresis; inflammatory bowel disease; leukocytapheresis; steroid-dependent; ulcerative colitis.

Figure 1.

Mean CAI score before and after LI-CAP: The CAI score (mean±SE) before and after LI-CAP is shown. The mean CAI score was significantly lower after LI-CAP than before (pre-CAI: 7.550 vs. post-CAI: 1.650, p<0.0001).

Figure 2.

The rate of clinical remission and discontinuation of steroids after LI-CAP: The rate of clinical remission after LI-CAP was 80.0% (16/20), and the rate of discontinuation of steroids after LI-CAP was 60.0% (12/20).

Figure 3.

Mean daily dose of prednisolone before and after LI-CAP: The daily prescribed dose of prednisolone (mean±SE) before and after LI-CAP is shown. The mean daily dose of prednisolone was significantly lower after LI-CAP (2.30 mg) than before therapy (17.30 mg) (p=0.0003).