Published online Mar 28, 2021. doi: 10.3748/wjg.v27.i12.1194
Peer-review started: November 4, 2020
First decision: January 23, 2021
Revised: February 11, 2021
Accepted: March 10, 2021
Article in press: March 10, 2021
Published online: March 28, 2021
Management of refractory ulcerative colitis (UC) patients is a crucial issue, and the goal of the treatment for such patients should be steroid-free remission. Although several breakthrough treatments, including biologics, have been developed for refractory UC, clinical studies focused on the achievement of steroid-free remission in refractory UC patients are insufficient.
Cytapheresis (CAP) is an effective therapeutic strategy for patients with active UC with fewer adverse effects. However, to date, the number of studies focused on the efficacy of CAP in both steroid-dependent and steroid-refractory UC has been limited. It is also important to assess the re-efficacy of CAP in patients who experience relapse after the first course of CAP.
The main objective of the study was to clarify the efficacy and re-efficacy of CAP in achieving steroid-free remission in refractory UC patients.
We retrospectively reviewed the collected data from 55 patients with refractory UC treated with CAP. We analyzed the efficacy of the first course of CAP, efficacy of the second, third, and fourth courses of CAP, and long-term efficacy of CAP.
The rates of clinical remission, steroid-free remission after CAP were 69.1%, 45.5%, respectively, and 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 83.3%, 83.3%, and 60%, respectively. The rates of sustained steroid-free remission were 68.0%, 60.0%, and 56.0% at 12, 24, and 36 mo after the CAP. These results showed that CAP effectively induced steroid-free remission in refractory UC patients and that patients achieving steroid-free remission after the first course of CAP responded to CAP repeatedly after that and had good long-term efficacy.
Our results suggest that CAP effectively induces and maintains steroid-free remission in both steroid-dependent and steroid-refractory UC patients and re-induces high-rate steroid-free remission repeatedly in patients achieving steroid-free remission after the first course of CAP. Considering the high level of safety of CAP, we suggest that CAP should be one of the first-line therapies for refractory UC patients and should be chosen as a first-line therapy for patients achieving steroid-free remission in the first course of CAP and thereafter experience relapses.
A multicenter prospective study with large sample sizes is required to warrant our results.