Endoscopic findings can predict the efficacy of leukocytapheresis for steroid-naive patients with moderately active ulcerative colitis

Abstract

AIM:To investigate the therapeutic usefulness of leukocytapheresis (LCAP; Cellsoba) in steroid-naive patients with moderately active ulcerative colitis (UC). METHODS: Eighteen steroid-naive patients with moderately active UC received one LCAP session every week for five consecutive weeks. RESULTS: The remission rate 8 weeks after the last LCAP session was 61.1% (11/18). All three patients with deep ulcers showed worsening after LCAP. For the remaining 15 patients, who had erosions or geographic ulcers, the average clinical activity index (CAI) score dropped significantly from 9.4 to 3.8 eight weeks after the last LCAP session (t = 4.89, P = 0.001). The average C-reactive protein (CRP) levels before and after LCAP were 1.2 mg/dL and 1.0 mg/dL, respectively. Of the patients with erosions, geographic ulcers, and deep ulcers, 100% (9/9), 33.3% (2/6), and 0% (0/3) were in remission 8 weeks after the last LCAP session, respectively (χ 2 = 7.65, P < 0.005). Fortyeight weeks after the last LCAP session, the remission rates for patients with erosions and geographic ulcers were 44.4% (4/9) and 16.7% (1/6), respectively. Only one patient suffered a mild adverse event after LCAP (nausea). CONCLUSION: LCAP is a useful and safe therapy for steroid-naive UC patients with moderate disease activity. Moreover, the efficacy of the treatment can be predicted on the basis of endoscopic findings.

Univariate Analysis to Examine Predictors of Response to Leukocytapheresis in Ulcerative Colitis Patients

“…Umehara et al. showed that: (i) the clinical course (with the exception of chronic continuous disease); and (ii) endoscopic findings (erosion >geographic ulcer >ulcer) predicted a good outcome . However, BMI was the only significant predictor in our study.…”

“…Takemoto et al reported that: (i) steroid dependency; and (ii) a high CRP level predicted a good outcome after LCAP therapy (10). Umehara et al showed that: (i) the clinical course (with the exception of chronic continuous disease); and (ii) endoscopic findings (erosion >geographic ulcer >ulcer) predicted a good outcome (18). However, BMI was the only significant…”

“…The following disease status parameters at the beginning of LCAP were included in the analysis: WBC count, neutrophil count and rate, CRP level, and ESR. Endoscopic findings were evaluated using the Rachmilewitz endoscopic score , and the patients were classified into three groups based on the endoscopic findings (ulcer, erosions, geographic ulcers), as previously reported .…”

“…Thus, LCAP is a therapeutic option for steroid‐dependent or steroid‐resistant patients with UC. Several reports have described background factors, such as the clinical course, endoscopic findings, and severity of disease as predictors of a good response to LCAP therapy and the possibility of recurrence after the therapy . However, a consensus regarding the use of LCAP therapy for patients with UC has not yet been established.…”

Novel adsorptive type apheresis device Immunopure for ulcerative colitis from clinical perspectives based on clinical trials: Japan and Europe

“…The effectiveness of Immnopure was also evaluated by comparing pooled results from this study and previous European clinical trials with the abovementioned data from publications concerning treatment with the CA and PET columns. Subgroup analyses of remission rates showed that remission was achieved in 70.4% of patients receiving Immunopure therapy vs. 61.8% to 67.3% of patients using other columns in the moderate disease population and in 69.6% vs. 51.7% to 74.1%, respectively, in the refractory disease population [ 2 , 5 , 6 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. This demonstrates that Immunopure is comparable to existing products in terms of clinical effectiveness in refractory moderate disease.…”