Published online Mar 28, 2021. doi: 10.3748/wjg.v27.i12.1194
Peer-review started: November 4, 2020
First decision: January 23, 2021
Revised: February 11, 2021
Accepted: March 10, 2021
Article in press: March 10, 2021
Published online: March 28, 2021
It is a crucial issue for patients with refractory ulcerative colitis (UC), including steroid-dependent and steroid-refractory patients, to achieve and maintain steroid-free remission. However, clinical studies focused on the achievement of steroid-free remission in refractory UC patients are insufficient. Cytapheresis (CAP) is a non-pharmacological extracorporeal therapy that is effective for active UC with fewer adverse effects. This study comprised UC patients treated with CAP and suggested the efficacy of CAP for refractory UC patients.
To clarify the efficacy of CAP in achieving steroid-free remission in refractory UC patients.
We retrospectively reviewed the collected data from 55 patients with refractory UC treated with CAP. We analyzed the following points: (1) Efficacy of the first course of CAP; (2) Efficacy of the second, third, and fourth courses of CAP in patients who experienced relapses during the observation period; (3) Efficacy of CAP in colonic mucosa; and (4) Long-term efficacy of CAP. Clinical efficacy was evaluated using Lichtiger’s clinical activity index or Sutherland index (disease activity index). Mucosal healing was evaluated using Mayo endoscopic subscore. The primary and secondary endpoints were the rate of achievement of steroid-free remission and the rate of sustained steroid-free remission, respectively. Statistical analysis was performed using the paired t-test and chi-squared test.
The rates of clinical remission, steroid-free remission, and poor effectiveness after CAP were 69.1%, 45.5%, and 30.9%, respectively. There were no significant differences in rate of steroid-free remission between patients with steroid-dependent and steroid-refractory UC. The mean disease activity index and Lichtiger’s clinical activity index scores were significantly decreased after CAP (P < 0.0001). The rates of steroid-free remission after the second, third, and fourth courses of CAP in patients who achieved steroid-free remission after the first course of CAP were 83.3%, 83.3%, and 60%, respectively. Mucosal healing was observed in all patients who achieved steroid-free remission after the first course of CAP. The rates of sustained steroid-free remission were 68.0%, 60.0%, and 56.0% at 12, 24, and 36 mo after the CAP. Nine patients (36%) had maintained steroid-free remission throughout the observation period.
Our results suggest that CAP effectively induces and maintains steroid-free remission in refractory UC and re-induces steroid-free remission in patients achieving steroid-free remission after the first course of CAP.
Core Tip: Management of steroid-dependent and steroid-refractory ulcerative colitis (UC) is a critical issue, and the goal of the therapy for such refractory UC should be steroid-free remission. However, clinical studies focused on the achievement of steroid-free remission in refractory UC patients are insufficient. In this study, we demonstrated that cytapheresis (CAP) was effective in inducing and maintaining steroid-free remission even in both steroid-dependent and steroid-refractory UC patients. Furthermore, it is notable that we also showed that CAP re-induced high-rate steroid-free remission repeatedly in such refractory UC patients who achieved steroid-free remission after the first course of CAP.