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. (Gut and Liver 2009;3:41-47)

Adsorptive Granulocyte/Monocyte Apheresis for the Maintenance of Remission in Patients with Ulcerative Colitis: A Prospective Randomized, Double Blind, Sham-Controlled Clinical Trial

“…GMA was done with the Adacolumn as previously described 2,4,5. Briefly, the Adacolumn is filled with specially designed cellulose acetate beads, which serve as the column adsorptive leucocytapheresis carriers 2.…”

“…Therefore, the primary goal was to evaluate the likely effective size and appropriate candidate patients for this non-drug intervention as a guide for subsequent evaluation in a large cohort of patients. Based on previous experience, 5 we assumed that 60% of patients without receiving GMA or be on placebo would have a clinical relapse within 1 year. Since this was a single institute trial, a power of 75% and a 2-sided type-I error rate of 5% were assumed.…”

“…In clinical setting, there is a need to establish an effective therapeutic strategy for long-term maintenance of remission without compromising safety. 5 Further, it might be reasonable to expect a strategy that is effective as remission induction therapy to work as maintenance therapy as well. An extracorporeal leucocytapheresis system like GMA is expected to have the potential to achieve this intention.…”

Efficacy and safety of adsorptive granulomonocytapheresis in Chinese patients with ulcerative colitis: A retrospective analysis of 50 cases with focus on factors impacting clinical efficacy

“…All patients received GMA therapy using an Adacolumn (JIMRO, Takasaki, Japan) twice a week as previously described 14‐16 . In brief, the Adacolumn and blood circuit lines were primed with sterile saline to remove air bubbles from the column void volume and flow lines, and then the system was primed with heparinized saline.…”

“…All patients received GMA therapy using an Adacolumn (JIMRO, Takasaki, Japan) twice a week as previously described. [14][15][16] In brief, the Adacolumn and blood circuit lines were primed with sterile saline to remove air bubbles from the column void volume and flow lines, and then the system was primed with heparinized saline. Intravenous access via the antecubital vein was initiated in one arm and the column outflow was returned via the antecubital vein in the contralateral arm.…”