Iizuka M, Etou T, Sagara S. Efficacy of cytapheresis in patients with ulcerative colitis showing insufficient or lost response to biologic therapy. World J Gastroenterol 2022; 28(34): 4959-4972 [PMID: 36160647 DOI: 10.3748/wjg.v28.i34.4959]
Corresponding Author of This Article
Masahiro Iizuka, MD, PhD, Director, Doctor, Akita Health Care Center, Akita Red Cross Hospital, 3-4-23 Nakadori, Akita 010-0001, Japan. maiizuka@woody.ocn.ne.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Sep 14, 2022; 28(34): 4959-4972 Published online Sep 14, 2022. doi: 10.3748/wjg.v28.i34.4959
Efficacy of cytapheresis in patients with ulcerative colitis showing insufficient or lost response to biologic therapy
Masahiro Iizuka, Takeshi Etou, Shiho Sagara
Masahiro Iizuka, Shiho Sagara, Akita Health Care Center, Akita Red Cross Hospital, Akita 010-0001, Japan
Masahiro Iizuka, Takeshi Etou, Department of Gastroenterology, Akita Red Cross Hospital, Akita 010-1495, Japan
Author contributions: Iizuka M was responsible for the conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version; Etou T and Sagara S was responsible for the critical revision and final approval of the final version.
Conflict-of-interest statement: There is no conflicts of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Masahiro Iizuka, MD, PhD, Director, Doctor, Akita Health Care Center, Akita Red Cross Hospital, 3-4-23 Nakadori, Akita 010-0001, Japan. maiizuka@woody.ocn.ne.jp
Received: May 30, 2022 Peer-review started: May 30, 2022 First decision: June 18, 2022 Revised: July 16, 2022 Accepted: August 16, 2022 Article in press: August 16, 2022 Published online: September 14, 2022
Abstract
For the optimal management of refractory ulcerative colitis (UC), secondary loss of response (LOR) and primary non-response to biologics is a critical issue. This 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 limitations. Further, 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 IM. There were no significant differences in the rate of remission and steroid-free remission between patients exposed or not exposed to thiopurines or IM. Three studies evaluated the efficacy of CAP in patients with UC showing an insufficient response to biologic therapies. Mean remission rates of biologics exposed or unexposed patients were 29.4 % and 44.2%, respectively. Fourteen studies evaluated the efficacy of CAP in combination with biologics in patients with inflammatory bowel disease showing a poor response or LOR to biologics. The 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%), respectively. CAP 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 biologics. Although 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 average. Given the excellent safety profile of CAP, this combination therapy can be an alternative therapeutic strategy for UC refractory to biologics. Extensive prospective studies are needed to understand the efficacy of combination therapy with CAP and biologics.
Core Tip: Management of refractory ulcerative colitis (UC) experiencing primary non-response or loss of response to biologics is a critical issue. We first summarized the efficacy of cytapheresis (CAP) for such patients. Although CAP tended to have lower effects for induction of remission in patients with UC who were refractory to biologics, combination therapies with CAP and biologics induced clinical remission or response in more than 40% of such patients with UC on average. Given the excellent safety profile of CAP, we believe that this combination therapy can be an alternative therapeutic strategy for such refractory UC patients.
