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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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cytapheresis for pyoderma gangrenosum associated with inflammatory bowel disease:A review of current status

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World Journal of Clinical Cases 2020年第11期8卷 2092-2101页

作者： Kentaro Tominaga Kenya Kamimura Hiroki Sato Masayoshi Ko Yuzo Kawata Takeshi Mizusawa Junji Yokoyama Shuji Terai Division of Gastroenterology and Hepatology Graduate School of Medical and Dental SciencesNiigata UniversityNiigata 951-8510Japan

Pyoderma gangrenosum(PG)is a neutrophilic dermatosis clinically characterized by the presence of painful skin ulcerations with *** it is frequently associated with inflammatory bowel diseases,including ulcerative colitis,gastroenterologists should be familiar with the disease including therapeutic ***,we have conducted a review focusing on the cytapheresis for PG in cases of inflammatory bowel diseases.A literature search was conducted to extract studies published in the last 20 years,with information on demographics,clinical symptoms,treatment,and the clinical course from a total of 22 cases reported and our recent *** most patients,cytapheresis was associated with improvement or resolution of PG after failure of conventional therapeutic options such as corticosteroids,antibiotics,immunosuppressive agents and *** on the information summarized,cytapheresis is helpful in the majority of patients with PG refractory to medical treatment associated with inflammatory bowel diseases and could be further studied in a multicenter,randomized trial.

关键词： Granulocytapheresis Leucocytapheresis cytapheresis Inflammatory bowel diseases Pyoderma gangrenosum Complications

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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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Efficacy of low-dose thiopurine therapy for the induction of remission in steroid-dependent ulcerative colitis: Comparison with cytapheresis

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Open Journal of Gastroenterology 2012年第1期2卷 9-14页

作者： Shuji Kochi Shotaro Nakamura Takayuki Matsumoto Department of Medicine and Clinical Science Graduate School of Medical Sciences Kyushu University Fukuoka Japan.

Background: The role of azathioprine (AZA) and 6-mercaptopurine (6-MP) in the induction of remission in patients with ulcerative colitis (UC) remains unclear. Aims: To compare the efficacy and safety of low-dose thiopurine (AZA/6-MP) and cytapheresis (CAP) for the induction of remission in patients with steroid- dependent UC. Patients and Methods: We reviewed the clinical course of 65 patients with steroid-dependent UC with moderate activity, who were treated with either low-dose AZA/6-MP (T-group, n = 38) or with CAP (C-group, n = 27). The efficacy and safety for the first 10 weeks after the start of the therapies were compared between the two groups. The cumulative probability curves of treatment failure were estimated by the Kaplan-Meier method. Clinical remission was defined as an ulcerative colitis activity index value of less than 150 without any other treatments. Results: Neither clinical characteristics, concomitant therapies, nor laboratory data (except for serum albumin levels) were different between the two groups. The remission rate at 10 weeks was not different between the two groups (55.3% in the T-group and 70.4% in the C-group, p = 0.22 in the intention-to-treat analysis). The frequencies of adverse events did not differ be- tween the two groups (p = 0.12). The cumulative pro- bability of treatment failure at 10 weeks was 44.7% for the T-group and 29.6% for the C-group (p = 0.23). Conclusions: Low-dose thiopurine therapy is an alter- native candidate for the induction of remission in pa- tients with steroid-dependent, moderate UC.

关键词： Ulcerative Colitis Azathioprine 6-Mercaptopurine cytapheresis Induction of Remission

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