Leukocytapheresis for steroid-dependent ulcerative colitis in clinical practice: results of a nationwide Spanish registry

• Published in: Journal of gastroenterology Vol. 47; no. 4; pp. 359 - 365
• Main Authors: Cabriada, J. L., Domènech, E., Ibargoyen, N., Hernández, V., Clofent, J., Ginard, D., Gutiérrez-Ibarluzea, I., Hinojosa, J.
• Format: Journal Article
• Language: English
• Published: Japan Springer Japan 01.04.2012; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Apheresis; Colitis, Ulcerative - drug therapy; Colitis, Ulcerative - therapy; Colorectal Surgery; Corticoids; Data processing; Databases, Factual; Female; Follow-Up Studies; Gastroenterology; Hepatology; Humans; infliximab; Kaplan-Meier Estimate; Leukapheresis - methods; Male; Medicine; Medicine & Public Health; Monoclonal antibodies; Original Article—Alimentary Tract; Remission; Remission Induction; Side effects; Spain; Steroid hormones; Steroids - therapeutic use; Surgical Oncology; Treatment Outcome; Tumor necrosis factor- alpha; Ulcerative colitis; Spain; Leukocytapheresis; Steroid-dependence; Ulcerative colitis
• ISSN: 0944-1174; 1435-5922
• DOI: 10.1007/s00535-011-0499-2

Background Several small, prospective, open studies suggest that leukocytapheresis might be efficient in patients with steroid-dependent ulcerative colitis (UC). Aim To evaluate the short- and long-term effectiveness of leukocytapheresis for the management of steroid-dependent UC in clinical practice. Methods A Web-based, nationwide database specifically designed to record the efficacy and safety data of leukocytapheresis therapy in UC was available from September 2007 in Spain. Clinical data were collected at treatment baseline, 1 month after the last apheresis session (initial efficacy), and 6 and 12 months thereafter (long-term efficacy). Remission was defined as a Mayo Clinic index ≤2 together with complete steroid withdrawal and response as a decrease of ≥3 from the baseline score. Results A total of 142 steroid-dependent UC patients were included in the registry, most of them treated with the Adacolumn™ system. In 69% of patients thiopurine therapy failed to achieve steroid-free clinical remission. Initial clinical remission was obtained in 37% of cases. The initial corticosteroid dose, the number and frequency of apheresis sessions, or the previous failure of thiopurines and/or infliximab did not influence the initial remission rate, but a greater decrease in CRP levels was associated with a higher probability to obtain initial remission. At 6 and 12 months, 41 and 36% of patients were in clinical remission, respectively. Only one serious adverse effect was recorded. Conclusions In clinical practice, apheresis allows long-term steroid-free clinical remission in up to one third of steroid-dependent UC patients, even in those with prior failure of thiopurines.