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Efficacy of cytapheresis in patients with ulcerative colitis showing insufficient or lost response to biologic therapy

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World Journal of Gastroenterology 2022年第34期28卷 4959-4972页

作者： Masahiro Iizuka takeshi etou Shiho Sagara Akita Health Care Center Akita Red Cross HospitalAkita 010-0001Japan Department of Gastroenterology Akita Red Cross HospitalAkita 010-1495Japan

For the optimal management of refractory ulcerative colitis(UC),secondary loss of response(LOR)and primary non-response to biologics is a critical *** article aimed to summarize the current literature on the use of cytapheresis(CAP)in patients with UC showing a poor response or LOR to biologics and discuss its advantages and ***,we summarized the efficacy of CAP in patients with UC showing insufficient response to thiopurines or immunomodulators(IM).Eight studies evaluated the efficacy of CAP in patients with UC with inadequate responses to thiopurines or *** were no significant differences in the rate of remission and steroid-free remission between patients exposed or not exposed to thiopurines or *** studies evaluated the efficacy of CAP in patients with UC showing an insufficient response to biologic *** remission rates of biologics exposed or unexposed patients were 29.4%and 44.2%,*** studies evaluated the efficacy of CAP in combination with biologics in patients with inflammatory bowel disease showing a poor response or LOR to *** rates of remission/response and steroid-free remission in patients with UC ranged 32%-69%(mean:48.0%,median:42.9%)and 9%-75%(mean:40.7%,median:38%),*** had the same effectiveness for remission induction with or without prior failure on thiopurines or IM but showed little benefit in patients with UC refractory to *** heterogeneity existed in the efficacy of the combination therapy with CAP and biologics,these combination therapies induced clinical remission/response and steroid-free remission in more than 40%of patients with UC refractory to biologics on *** the excellent safety profile of CAP,this combination therapy can be an alternative therapeutic strategy for UC refractory to *** prospective studies are needed to understand the efficacy of combination therapy with CAP and biologics.

关键词： Ulcerative colitis Inflammatory bowel disease Cytapheresis Granulocyte and monocyte adsorptive apheresis Anti-tumor necrosis factor-αantibody Combination therapy

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Cytapheresis re-induces high-rate steroid-free remission in patients with steroid-dependent and steroid-refractory ulcerative colitis

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World Journal of Gastroenterology 2021年第12期27卷 1194-1212页

作者： Masahiro Iizuka takeshi etou Yosuke Shimodaira Takashi Hatakeyama Shiho Sagara Akita Health Care Center Akita Red Cross HospitalAkita 010-0001Japan Department of Gastroenterology Akita Red Cross HospitalAkita 010-1495Japan Department of Gastroenterology and Neurology Akita University Graduate School of MedicineAkita 010-8543Japan akashi Hatakeyama Department of NephrologyAkita Red Cross HospitalAkita 010-1495Japan

BACKGROUND 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 ***,clinical studies focused on the achievement of steroid-free remission in refractory UC patients are ***(CAP)is a non-pharmacological extracorporeal therapy that is effective for active UC with fewer adverse *** study comprised UC patients treated with CAP and suggested the efficacy of CAP for refractory UC *** To clarify the efficacy of CAP in achieving steroid-free remission in refractory UC *** We retrospectively reviewed the collected data from 55 patients with refractory UC treated with *** 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 *** efficacy was evaluated using Lichtiger’s clinical activity index or Sutherland index(disease activity index).Mucosal healing was evaluated using Mayo endoscopic *** primary and secondary endpoints were the rate of achievement of steroidfree remission and the rate of sustained steroid-free remission,*** analysis was performed using the paired t-test and chi-squared *** The rates of clinical remission,steroid-free remission,and poor effectiveness after CAP were 69.1%,45.5%,and 30.9%,*** were no significant differences in rate of steroid-free remission between patients with steroiddependent and steroid-refractory *** 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 8

关键词： Ulcerative colitis Cytapheresis Steroid-dependent Steroid-refractory Steroid-free remission Inflammatory bowel disease

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Typical gastroduodenal endoscopic findings in a Crohn's disease patient in remission stage

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World Journal of Gastrointestinal Endoscopy 2012年第3期4卷 96-98页

作者： Masahiro Iizuka Taku Harada Hiro-o Yamano takeshi etou Shiho Sagara Department of Gastroenterology Akita Red Cross HospitalAkita 010-1495Japan Akita Health Care Center Akita Red Cross Hospital

A 39-year-old patient with Crohn's disease (CD) was referred to our hospital for maintenance treatment of *** was diagnosed as having CD of the small and large intestines at 32 years *** underwent partial resection of the ileum at 35 years old because of ileal *** had received enteral nutritional supplement (1200 kcal/d) and metronidazole preparation (500 mg/d),and was in remission Crohn's disease activity index *** performed a routine gastroduodenal endoscopic examination,which revealed the representative endoscopic findings of gastroduodenal lesions in CD,namely,bamboo-joint-like appearance of the gastric body and cardia and a notched sign in the *** findings were clearly observed by using indigo carmine dye *** our patient,typical gastroduodenal findings were observed even in the remission stage,suggesting that these findings would contribute to the early diagnosis of CD not only in the active stage but also during remission.

关键词： Crohn’s disease Gastroduodenal findings Bamboo-joint-like appearance Notched sign

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