Centrifugal leukocytapheresis therapy for ulcerative colitis without concurrent corticosteroid administration.
Corticosteroid administration is an important therapy for active ulcerative colitis. However, long-term corticosteroid use is associated with serious complications such as osteoporosis, diabetes, and growth retardation. The effect of combination therapy corticosteroid plus leukocytapheresis has been previously reported, but that of leukocytapheresis with no corticosteroid is unknown. We carried out a preliminary study of six patients (two men and four women) with active ulcerative colitis (severe in two, moderately severe in four) who did not respond to 5-aminosalicylate derivatives, but refused corticosteroid use. Centrifugal leukocytapheresis was carried out once per week totaling four sessions per course. Treatment was considered effective when patients experienced clinical remission, which was defined as a frequency of diarrhea of four times or less and absence of visible blood in the stool, after one course. Leukocytapheresis was effective in five of six patients(83%). With cases stratified by severity, both severe cases and three of four moderately severe cases showed effectiveness. Clinical activity scores according to Lichtiger et al. in cases where leukocytapheresis was effective decreased from 9.8 to 6.6 at 1 week (P < 0.0001), declining further 2.4 at the end of the course. No obvious complications of leukocytapheresis were noted except for a decrease in hemoglobin by 1 g/dL. Centrifugal leukocytapheresis without corticosteroid treatment can induce remission in patients with active ulcerative colitis, and might be particularly beneficial for patients in whom adverse effects preclude the use of corticosteroids.
Okada
Hiroyuki
H
Department of Medicine and Medical Science, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan. hiro@md.okayama-u.ac.jp
Takenaka
Ryuta
R
Hiraoka
Sakiko
S
Makidono
Chiho
C
Hori
Shin-Ichiro
S
Kato
Jun
J
Okazaki
Hiroaki
H
Kawamoto
Hirofumi
H
Mizuno
Motowo
M
Shiratori
Yasushi
Y
D000293:Adolescent; D000305:Adrenal Cortex Hormones; D000328:Adult; D000368:Aged; D003093:Colitis, Ulcerative / Q000628:therapy*; D000075202:Contraindications; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D007937:Leukapheresis / Q000379:methods*; D008297:Male; D019804:Mesalamine / Q000494:pharmacology; D008875:Middle Aged; D010289:Parenteral Nutrition, Total / Q000379:methods; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D019804:Mesalamine