title: Factors affecting short- and long-term effects of leukocyte removal therapy in active ulcerative colitis.
abstract: OBJECTIVE
  Leukocyte removal therapy (LRT) is recognized as an effective treatment for active ulcerative colitis (UC). In this study, factors associated with the efficacy and long-term effects of LRT were evaluated.
  
  
  METHODS
  From April 1998 to March 2010, 98 patients with moderate to severe UC were randomly assigned to granulocyte and monocyte/macrophage adsorptive apheresis (GMA) (n = 47) or leukocytapheresis (LCAP) (n = 51) treatment. Patients received two sessions of LRT in the first week, followed by three weekly administrations. All patients were treated with 5-aminosalicylic acid and corticosteroid. Steroid doses were tapered if patients achieved clinical improvement. Clinical remission was defined as a decrease in clinical activity index to < 4 and endoscopic findings to Matts' grade 1 or 2. When clinical activity index decreased but still remained ≥ 5 and Matts' grading was 1 or 2, the patient was considered to have improved. Patients were observed for at least 1 year and diagnosed as relapsed when additional treatment was required.
  
  
  RESULTS
  Seventy-one (73%) patients achieved clinical remission or improvement. No significant difference was found between LCAP and GMA. Increased age, ≥ 3 attacks of UC, and ≥ 2 sessions of LRT were indicative of refractoriness to LRT. During 1 year observation, 28 patients were relapsed. Duration of UC, ≥ 3 attacks of UC, and ≥ 2 sessions of LRT were indicative of refractoriness to the long-term effects of LRT.
  
  
  CONCLUSIONS
  Both GMA and LCAP were effective to treat active UC. However, long duration of UC, multiple UC attacks, and past history of LRT reduce the efficacy.
authors: Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School, Saga, Japan.
authors: Ryo
authors: R
authors: Nakano
authors: Ryuichi
authors: R
authors: Iwakiri
authors: Yuji
authors: Y
authors: Ikeda
authors: Tomoya
authors: T
authors: Kishi
authors: Nanae
authors: N
authors: Tsuruoka
authors: Ryo
authors: R
authors: Shimoda
authors: Yasuhisa
authors: Y
authors: Sakata
authors: Kanako
authors: K
authors: Yamaguchi
authors: Kazuma
authors: K
authors: Fujimoto
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002648:Child; D003093:Colitis, Ulcerative / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D016238:Cytapheresis / Q000379:methods*; D004359:Drug Therapy, Combination; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006098:Granulocytes / Q000276:immunology; D006801:Humans; D007564:Japan; D007937:Leukapheresis; D008264:Macrophages / Q000276:immunology; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use; D008875:Middle Aged; D009000:Monocytes / Q000276:immunology; D012008:Recurrence; D012074:Remission Induction; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D005765:Gastrointestinal Agents; D019804:Mesalamine