Long-term prognosis of patients with ulcerative colitis treated with cytapheresis therapy.
BACKGROUND
Although accumulating studies in Japan show that cytapheresis (CAP) therapy is safe and effective for the induction of remission of moderate or severe ulcerative colitis (UC), the long-term prognosis of UC patients treated with CAP is unknown. The aim of this study was to determine the long-term prognosis of UC patients treated with CAP.


METHODS
Ninety patients treated previously with CAP and followed for more than 3 years were evaluated. The rates of operation, readmission, and use or dose-up of corticosteroid were analyzed as long-term prognosis.


RESULTS
Following the first course of CAP treatment, 64% of patients showed clinical improvement (> 4-point decrease in the clinical activity index (CAI)), and 49% of patients achieved clinical remission (CAI ≤ 4). Longer disease duration and lower age at the first CAP treatment correlated significantly with the therapeutic effects of CAP (p = 0.003 and 0.035, respectively). The rates of operation and readmission were significantly lower in patients who showed previous clinical effects of CAP than in those who did not respond to CAP. The rates of operation and readmission were also significantly lower in patients whose treatment was combined with immunomodulators after the initiation of CAP than in patients who did not use immunomodulators. Importantly, the second course of CAP was also effective in most of the patients who showed a clinical response to the first CAP.


CONCLUSIONS
Patients who achieve remission after the first CAP therapy may have a good long-term prognosis and a good response to a second CAP therapy even after relapse.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
Tetsuro
T
Takayama
Takanaori
T
Kanai
Katsuyoshi
K
Matsuoka
Susumu
S
Okamoto
Tomohisa
T
Sujino
Yohei
Y
Mikami
Tadakazu
T
Hisamatsu
Tomoharu
T
Yajima
Yasushi
Y
Iwao
Haruhiko
H
Ogata
Toshifumi
T
Hibi
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000601:surgery / Q000628:therapy*; D016238:Cytapheresis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D008297:Male; D015122:Mercaptopurine / Q000031:analogs & derivatives / Q000627:therapeutic use; D008875:Middle Aged; D010359:Patient Readmission; D011239:Prednisolone / Q000627:therapeutic use; D011379:Prognosis; D012074:Remission Induction; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult
D000893:Anti-Inflammatory Agents; D007155:Immunologic Factors; C488629:azathiopurine; D011239:Prednisolone; D015122:Mercaptopurine