Efficacy and endoscopic prediction of cytapheresis therapy in patients with refractory and steroid-dependent ulcerative colitis

Background: Recently, it has been proved in Japan that granulocyte and monocyte adsorption apheresis (GCAP) and leukocytapheresis (LCAP) are effective and safe for patients with moderate to severe ulcerative colitis (UC). Aim: To investigate the efficacy of GCAP and LCAP in patients with active UC, and the use of endoscopic findings in predicting efficacy, especially in refractory and steroid-dependent cases. Subjects and methods: Thirty-four patients with active UC (24 refractory to conventional therapy and 10 steroid-dependent) were treated with GCAP (n = 21) or LCAP (n = 13). The patients received one or two GCAP or LCAP sessions per week for 5 consecutive weeks, with colonoscopy before and after each session. Results: About 70% of the patients achieved a clinical response, and no severe adverse effects were observed. Most steroid-dependent patients or patients who had side effects due to steroids were controlled successfully. Endoscopically, 14 of 16 cases with shallow ulcers and erosion throughout the colon and 10 of 15 with deep ulcerations responded to treatment. However, three with massive ulceration of the whole mucosa did not respond. Conclusions: GCAP or LCAP are valuable therapies for refractory or steroid-dependent UC, and endoscopic findings are helpful in predicting clinical effectiveness.