title: The efficacy and safety of selective leukocytapheresis in the treatment of ulcerative colitis: a meta-analysis.
abstract: OBJECTIVE
  The use of selective leukocytapheresis for the treatment of ulcerative colitis (UC) has been evaluated in several open and controlled trials, with varying outcomes. A meta-analysis was performed to better assess the efficacy and safety of selective leukocytapheresis as supplemental therapy compared with conventional pharmacotherapy in patients with UC.
  
  
  METHODS
  All randomized trials comparing selective leukocytapheresis supplementation with conventional pharmacotherapy were included from electronic databases and reference lists. A meta-analysis that pooled the outcome effects of leukocytapheresis and pharmacotherapy was performed. A fixed effect model or random effect model was selected depending on the heterogeneity test of the trials.
  
  
  RESULTS
  Nine randomized controlled trials met the inclusion criteria contributing a total of 686 participants. Compared with conventional pharmacotherapy, leukocytapheresis supplementation presented a significant benefit in promoting a response rate (OR, 2.88, 95% CI: 1.60-5.18) and remission rate (OR, 2.04; 95% CI, 1.36-3.07) together with significant higher steroid-sparing effects (OR, 10.49; 95% CI, 3.44-31.93) in patients with active moderate-to-severe UC by intention-to-treat analysis. Leukocytapheresis was more effective in maintaining clinical remission for asymptomatic UC patients than conventional therapy (OR, 8.14; 95% CI, 2.22-29.90). The incidence of mild-moderate adverse effects was much less frequent in the leukocytapheresis groups than conventional pharmacotherapy groups (OR, 0.16; 95% CI, 0.04-0.60). Few severe adverse events were observed.
  
  
  CONCLUSIONS
  Current data indicate that leukocytapheresis supplementation may be more efficacious on improving response and remission rates and tapering corticosteroid dosage with excellent tolerability and safety than conventional pharmacotherapy in patients with UC. In addition, more high-quality randomized controlled trials are required to confirm the higher efficacy of leukocytapheresis in patients with UC.
authors.affiliation: Department of Gastroenterology, Renji Hospital, Shanghai Institute of Digestive Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, 200001, China.
authors.forename: Mingming
authors.initials: M
authors.lastname: Zhu
authors.forename: Xitao
authors.initials: X
authors.lastname: Xu
authors.forename: Fang
authors.initials: F
authors.lastname: Nie
authors.forename: Jinlu
authors.initials: J
authors.lastname: Tong
authors.forename: Shudong
authors.initials: S
authors.lastname: Xiao
authors.forename: Zhihua
authors.initials: Z
authors.lastname: Ran
mesh_terms: D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism; D003093:Colitis, Ulcerative / Q000097:blood / Q000628:therapy*; D006801:Humans; D007937:Leukapheresis; D017594:Publication Bias; D012074:Remission Induction; D012449:Safety; D016896:Treatment Outcome
chemical_list: D002097:C-Reactive Protein