Iizuka M, Etou T, Shimodaira Y, Hatakeyama T, Sagara S. Cytapheresis re-induces high-rate steroid-free remission in patients with steroid-dependent and steroid-refractory ulcerative colitis. World J Gastroenterol 2021; 27(12): 1194-1212 [PMID: 33828394 DOI: 10.3748/wjg.v27.i12.1194]
Corresponding Author of This Article
Masahiro Iizuka, MD, PhD, Director, Doctor, Akita Health Care Center, Akita Red Cross Hospital, 3-4-23 Nakadori, Akita 010-0001, Japan. maiizuka@woody.ocn.ne.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Masahiro Iizuka, Shiho Sagara, Akita Health Care Center, Akita Red Cross Hospital, Akita 010-0001, Japan
Masahiro Iizuka, Takeshi Etou, Department of Gastroenterology, Akita Red Cross Hospital, Akita 010-1495, Japan
Yosuke Shimodaira, Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita 010-8543, Japan
Takashi Hatakeyama, Department of Nephrology, Akita Red Cross Hospital, Akita 010-1495, Japan
Author contributions: Iizuka M contributed to this paper with conception and design and performance of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version; Etou T contributed this paper with performance of the study, critical revision of the final version; Shimodaira Y contributed this paper with design of the study, critical revision and final approval of the final version; Hatakeyama T contributed this paper with supporting cytapheresis and critical revision of the final version; Sagara S contributed this paper with performance of the study, critical revision of the final version.
Institutional review board statement: This retrospective study was reviewed and approved by the Institutional Review Board of Akita Red Cross Hospital (approval No: 195) and Akita University School of Medicine (approval No: 2419).
Informed consent statement: Written or oral informed consent was obtained from patients and/or parents of patients aged younger than 20 years.
Conflict-of-interest statement: We declare no conflict-of-interest associated with this manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Masahiro Iizuka, MD, PhD, Director, Doctor, Akita Health Care Center, Akita Red Cross Hospital, 3-4-23 Nakadori, Akita 010-0001, Japan. maiizuka@woody.ocn.ne.jp
Received: November 4, 2020 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
ARTICLE HIGHLIGHTS
Research background
Management of refractory ulcerative colitis (UC) patients is a crucial issue, and the goal of the treatment for such patients should be steroid-free remission. Although several breakthrough treatments, including biologics, have been developed for refractory UC, clinical studies focused on the achievement of steroid-free remission in refractory UC patients are insufficient.
Research motivation
Cytapheresis (CAP) is an effective therapeutic strategy for patients with active UC with fewer adverse effects. However, to date, the number of studies focused on the efficacy of CAP in both steroid-dependent and steroid-refractory UC has been limited. It is also important to assess the re-efficacy of CAP in patients who experience relapse after the first course of CAP.
Research objectives
The main objective of the study was to clarify the efficacy and re-efficacy of CAP in achieving steroid-free remission in refractory UC patients.
Research methods
We retrospectively reviewed the collected data from 55 patients with refractory UC treated with CAP. We analyzed the efficacy of the first course of CAP, efficacy of the second, third, and fourth courses of CAP, and long-term efficacy of CAP.
Research results
The rates of clinical remission, steroid-free remission after CAP were 69.1%, 45.5%, respectively, and 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. The rates of sustained steroid-free remission were 68.0%, 60.0%, and 56.0% at 12, 24, and 36 mo after the CAP. These results showed that CAP effectively induced steroid-free remission in refractory UC patients and that patients achieving steroid-free remission after the first course of CAP responded to CAP repeatedly after that and had good long-term efficacy.
Research conclusions
Our results suggest that CAP effectively induces and maintains steroid-free remission in both steroid-dependent and steroid-refractory UC patients and re-induces high-rate steroid-free remission repeatedly in patients achieving steroid-free remission after the first course of CAP. Considering the high level of safety of CAP, we suggest that CAP should be one of the first-line therapies for refractory UC patients and should be chosen as a first-line therapy for patients achieving steroid-free remission in the first course of CAP and thereafter experience relapses.
Research perspectives
A multicenter prospective study with large sample sizes is required to warrant our results.
