Factors affecting short- and long-term effects of leukocyte removal therapy in active ulcerative colitis.

Abstract

BACKGROUND AND AIM:

Leukocyte removal therapy (LRT) is recognized as an effective treatment for active ulcerative colitis (UC). In this study, factors associated with the efficacy and long-term effects of LRT were evaluated.

METHODS:

From April 1998 to March 2010, 98 patients with moderate to severe UC were randomly assigned to granulocyte and monocyte/macrophage adsorptive apheresis (GMA) (n = 47) or leukocytapheresis (LCAP) (n = 51) treatment. Patients received two sessions of LRT in the first week, followed by three weekly administrations. All patients were treated with 5-aminosalicylic acid and corticosteroid. Steroid doses were tapered if patients achieved clinical improvement. Clinical remission was defined as a decrease in clinical activity index to < 4 and endoscopic findings to Matts' grade 1 or 2. When clinical activity index decreased but still remained ≥ 5 and Matts' grading was 1 or 2, the patient was considered to have improved. Patients were observed for at least 1 year and diagnosed as relapsed when additional treatment was required.

RESULTS:

Seventy-one (73%) patients achieved clinical remission or improvement. No significant difference was found between LCAP and GMA. Increased age, ≥ 3 attacks of UC, and ≥ 2 sessions of LRT were indicative of refractoriness to LRT. During 1 year observation, 28 patients were relapsed. Duration of UC, ≥ 3 attacks of UC, and ≥ 2 sessions of LRT were indicative of refractoriness to the long-term effects of LRT.

CONCLUSION:

Both GMA and LCAP were effective to treat active UC. However, long duration of UC, multiple UC attacks, and past history of LRT reduce the efficacy.

• Authors: Ryo Nakano, Ryuichi Iwakiri, Yuji Ikeda, Tomoya Kishi, Nanae Tsuruoka, Ryo Shimoda, Yasuhisa Sakata, Kanako Yamaguchi, Kazuma Fujimoto
• Journal: Journal of gastroenterology and hepatology (J Gastroenterol Hepatol) Vol. 28 Issue 2 Pg. 303-8 (Feb 2013) ISSN: 1440-1746 [Electronic] Australia
• PMID: 23339387 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)
• Copyright: © 2012 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

Chemical References

• Adrenal Cortex Hormones
• Anti-Inflammatory Agents
• Gastrointestinal Agents
• Mesalamine

Topics

• Adolescent
• Adrenal Cortex Hormones (therapeutic use)
• Adult
• Aged
• Aged, 80 and over
• Anti-Inflammatory Agents (therapeutic use)
• Child
• Colitis, Ulcerative (immunology, pathology, therapy)
• Cytapheresis (methods)
• Drug Therapy, Combination
• Endoscopy, Gastrointestinal
• Female
• Gastrointestinal Agents (therapeutic use)
• Granulocytes (immunology)
• Humans
• Japan
• Leukapheresis
• Macrophages (immunology)
• Male
• Mesalamine (therapeutic use)
• Middle Aged
• Monocytes (immunology)
• Recurrence
• Remission Induction
• Risk Factors
• Severity of Illness Index
• Time Factors
• Treatment Outcome
• Young Adult