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

Table 1 Patients’ characteristics in this study

Characteristics
Age (yr, mean ± SD)	16-82 (38.7 ± 16.7)
Sex	Male 29, female 26
Disease duration from diagnosis (mo, mean ± SD)	1-384 (59.4 ± 78.8)
Disease extent
Left-sided colitis	12
Pancolitis	43
Disease refractory type
Steroid-dependent	33
Steroid-refractory	21
Refusal of steroids	1
Clinical type
One-attack	4
Relapsing-remitting	50
Chronic continuous	1
Mean CAI (mean ± SE) (pre first course of CAP)	9.0 ± 0.62
Mean DAI (mean ± SE) (pre first course of CAP)	11.3 ± 0.55
Medication (pre first course of CAP)
PSL (oral)	Yes 54, no 1
5-ASA	Yes 52, no 3
Thiopurines	Yes 12, no 43
TNF-α antibodies	Yes 1 (adalimumab), no 54
Vedolizumab, tofacitinib, tacrolimus, ustekinumab	Yes 0, no 55
Dose of PSL at the start of CAP (mean ± SD)	0-60 mg (33.4 ± 19.2)
Type of CAP	GMA 38, LCAP 17
Observation period after the first course of CAP (mo, mean ± SD)	18-193 (81.5 ± 47.3)

CAI: Lichtiger’s clinical activity index; DAI: Sutherland index (disease activity index); PSL: Prednisolone; 5-ASA: 5-Aminosalicylic acid; CAP: Cytapheresis; GMA: Granulocyte and monocyte adsorptive apheresis; LCAP: Leukocytapheresis.

Table 2 Laboratory data obtained (mean ± SE) before and after cytapheresis

	Before CAP	After CAP	P value
CRP (mg/dL)	1.795 ± 0.721	0.312 ± 0.130	P = 0.0396
Albumin (g/dL)	3.579 ± 0.139	3.911 ± 0.117	P = 0.0358
Neutrophil count (μL)	6826 ± 561	5475 ± 456	P = 0.0124
Monocyte count (μL)	588 ± 73	425 ± 46	P = 0.0626

CRP: C-reactive protein; CAP: Cytapheresis.

Table 3 Previous studies examining the efficacy of cytapheresis in refractory ulcerative colitis

Ref.	Refractory type	Number of patients	Evaluation items1	Rate of remission (evaluation time)	Rate of steroid- free remission (evaluation time)
Naganuma et al[44] (2004)	SR	10	Induction	Severe 20%, moderate 70%
Giampaolo et al[45] (2006)	SR	8	Induction, sustained remission	100%	100%, 12.5% (12 mo)
Ricart et al[46] (2007)	SD	20	Induction, sustained remission	42.1% (17 wk)	36.8% (17 wk), 85.7% (12 mo)
Cabriada et al[47] (2010)	SD	18	Induction, sustained remission		55% (1 mo), 75% (12 mo)
Cabriada et al[48] (2012)	SD	142	Induction, sustained remission		37% (1 mo), 51%2 (12 mo)
Sacco et al[49] (2013)	SD + SR	83 (SD 55, SR 28)	Induction, sustained remission	71%, 48% (12 mo)
Yokoyama et al[43] (2014)	SD + SR	401 (SD 229, SR 172)	Induction	SD: 64.6% (2 wk), SR: 70.9 (2 wk)
Dignass et al[50] (2016)	SD	86	Induction	39.3% (12 wk)	22.6% (12 wk)
Imperiali et al[51] (2017)	SD	33	Induction		36% (12 mo)
Dignass et al[52] (2018)	SD	95	Induction	34.0% (24 wk), 33.0% (48 wk)	19.2% (24 wk), 19.2% (48 wk)
Domènech et al[53] (2018)	SD	63	Induction		13% (24 wk)
Present study	SD + SR	55 (SD 33, SR 21)	Induction, sustained remission	SD: 69.7% (4 wk), SR: 66.7% (4 wk)	SD: 42.4% (4 wk) SR: 47.6% (4 wk); SD: 69.2% (12 mo), SR: 63.6% (12mo)

¹Evaluation items, which include Induction (evaluation for induction of remission or steroid-free remission) and sustained remission (evaluation for maintenance of sustained remission or steroid-free remission).

²Rate of sustained steroid-free remission in the patients with no additional apheresis. SR: Steroid refractory; SD: Steroid dependent.