Mamoru Watanabe 1, Daisuke Kubota, Masakazu Nagahori, Takanori Kanai , Intern Med
. 2007;46(16):1305-6.
Tag: Leukocytapheresis
Evidencia científica
Treatment of inflammatory immunologic disease: Leukocytapheresis for inflammatory immunologic disease (tentative)
Opinion about effectiviness, safety , number of treated patientes and potential indications of LCAP and GMA.
Evidencia científica
Leukocytapheresis: Filtering Out the Facts
P. Irving D S Rampton 2007 chapter 29 part 3 Medical treatment: What’s Round the corner? DOI:10.1002/9780470750827.ch29
cost / Crohn's disease / efficacy / gma / Leukocytapheresis / Safety / steroid tapering / ulcerative colitis /
Evidencia científica
Role of leukocytapheresis in the management of inflammatory bowel disease
Ken Fukunaga, Hiroto Miwa, Takayuki Matsumoto January 2007 Tropical gastroenterology: official journal of the Digestive Diseases Foundation 28(1):11-5
Ulcerative colitis (UC) together with Crohn’s disease (CD) constitute idiopathic inflammatory bowel diseases (IBD) of the gut. The etiology of IBD is poorly understood, but autoimmune-disturbance has been suggested to play an important role in this incurable disease. Extracorporeal leukocyte removal therapy (ELRT) is the latest adjunct for IBD patient refractory to steroids, and it aims at suppressing immunological response by removing circulating leukocytes, especially granulocytes, from the blood stream. The present paper reviews the latest evidences in order to propose the current status of ELRT in the therapeutic strategy for IBD, especially for UC and CD. Clinical experience so far suggests that ELRT has superior efficiency as a non-pharmacological immuno-modulative therapy for steroid resistant UC patients before submission to colectomy. Moreover, ELRT has been proven to be a safe therapy compared with other current medications for severe UC.
Crohn's disease / efficacy / gma / IBD / Leukocytapheresis / MOA / Safety / Steroid-refractory / ulcerative colitis /
Evidencia científica
Leukocytapheresis in Patients with Moderate-Severe Steroid-Dependant Ulcerative Colitis: Clinical Response without Endoscopic Response
Irene Modesto, Daniela Scimeca, Ambrogio Orlando, Mario Cottone, Inflamm Bowel Dis 12 (10), October 2006
We report the results of an open prospective study of LCAP in moderate to severe steroid-dependent UC. LCAP is an effective procedure in obtaining discontinuation of steroids in 36% of patients with UC for at least 3 months. Overall 4 of 11(36%) patients could discontinue steroids within 3 months. No relevant side effects were observed. The procedure was well tolerated. In our series, there was no endoscopic response. Most of the patients obtained a clinical temporary response, but many relapsed
Evidencia científica
Therapeutic efficacy of leukocytapheresis in a pregnant woman with severe active ulcerative colitis
H Okada 1, C Makidono, R Takenaka, S Hiraoka, A Fujiwara, J Kato, Y Kawahara, H Kawamoto, M Mizuno, Y Shiratori
Leukocytapheresis has recently been used to induce remission in patients with ulcerative colitis (UC) who fail to respond to corticosteroids. We could not find a report in the literature on leukocytapheresis for UC with gestational exacerbation. We have recently encountered this unique condition and report the details here. A 30-year-old Japanese woman with left-sided severe UC was corticosteroid-dependent and had recurrence of the active disease during tapering of corticosteroid. She declined any dose increase and the use of any immunosuppressive agent because she was in the 13th week of pregnancy. Then, concomitant leukocytapheresis was performed without increasing the corticosteroid dose. Recovery was rapid and dramatic. Mucous and bloody stool decreased after the first session, and she had remission 2 weeks later. She underwent a total of four sessions without complications. After 6 weeks, she was discharged from our hospital and underwent maintenance treatment as an outpatient with mesalazine and corticosteroid tapering. Subsequently, she gave birth to a healthy baby girl by an uncomplicated vaginal delivery while keeping the remitted stage of UC.
Evidencia científica
Predictors of a response to cyclosporine or leukocyte removal therapy in patients with refractory ulcerative colitis
TAKAFUMI ANDO, OSAMU WATANABE, RYUICHI FURUTA, OSAMU MAEDA, YUJI NISHIO,
TSUYOSHI NISHIWAKI, KENJI INA, KAZUO KUSUGAMI AND HIDEMI GOTO Digestive Endoscopy (2005) 17, 153–158
Introduction: Despite decades of clinical experience in optimizing the induction and maintenance of remission in patients with ulcerative colitis (UC), some patients remain refractory to conventional medical treatment while, in others, the effectiveness of drugs is limited by side-effects. We investigated factors predictive of the efficacy of cyclosporine and leukocyte removal therapy in patients with intractable UC. Methods: Forty-five patients with moderate to severe UC who were refractory to corticosteroid therapy were enrolled. Twenty-six patients were treated with cyclosporine and 19 by leukocyte removal therapy. Disease activity index (DAI) score assessment, and colonoscopic and histological examinations were done before and at 10, 20 and 40 days after the initiation of treatment. A clinical response to treatment was defined as a decrease in DAI score of 3 points or more at 40 days. Results: Responder ratio did not significantly differ between the cyclosporine (65.6%) and leukocyte removal therapy (63.2%) groups. Factors predictive of a response to cyclosporine therapy were fever (≥ 38.0∞C), anemia and large mucosal ulceration. In contrast, mucosal bleeding and poor extensibility of the intestinal lumen were predictive of a poor response to cyclosporine. No significant differences in any clinical or endoscopic parameter predictive of a response to leukocyte removal therapy were identified. Conclusions: Intravenous cyclosporine may be effective in patients who have severe steroid-refractory UC, and leukocyte removal therapy may be useful in patients with moderate active UC predicted to be refractive to cyclosporine.
Evidencia científica
Leukocytapheresis (LCAP) for Management
of Fulminant Ulcerative Colitis with
Toxic Megacolon
Dig Dis Sci 2005 Apr;50(4):767-73. doi: 10.1007/s10620-005-2571-3.
Leukocytapheresis (LCAP) is a method of therapeutic apheresis to remove patients’ peripheral leukocytes by extracorporeal circulation. Previous studies showed that LCAP for the treatment of ulcerative colitis (UC) was more effective and had fewer adverse effects compared to high-dose steroid therapy. However, there are no reports on the application of LCAP for UC patients with toxic megacolon (TM). This study reports the effectiveness and safety of LCAP in treating patients with severe or fulminant UC with TM. Six patients were enrolled in this study and LCAP sessions were performed three times per week for 2 weeks, followed by four further times in the next 4 weeks. After completion of therapy, four patients improved in TM and went into the remission stage of UC. The average Rachmilewitz clinical activity index of these four patients improved from 19.5 to 1. The remaining two patients had to undergo colectomy, however, the symptoms had been mitigated by LCAP and the operations were completed without any problems. These results suggest that LCAP is an additional effective and safe option for TM management in preventing colectomy or for bridging to a safer operation.
Evidencia científica
Leucocytapheresis for ulcerative colitis
P.M. Irving, D.S. Rampton
Digestive and Liver Disease 36 (2004) 799–802
we discuss the theory behind using leucocytapheresis to treat IBD, its different forms, the way in which these remove leucocytes, and the indications, efficacy, safety, and possible future role of leucocytapheresis.
if randomised controlled trials confirm its safety and efficacy in steroid-refractory colitis, it would be tempting to compare leucocytapheresis with cyclosporin rescue therapy in that it can be used on an out-patient basis and, unlike cyclosporin, is not yet reported to have serious side-effects. Furthermore, in patients refractory to aminosalicylates, leucocytapheresis could conceivably have a place as maintenance therapy. Azathioprine and 6-mercaptopurine are not always effective and have rare
but serious side-effects; leucocytapheresis, at least in theory, might be an attractive alternative.
Evidencia científica
Leukocytapheresis with leukocyte removal filter for severe ulcerative colitis in childhood
Generally, UC is associated with intervals of acute exacerbation and the administration of corticosteroids is effective in bringing about a clinical remission (1). Corticosteroids are not always effective even in doses over 1 mg/kg/day. In addition, the long-term use of corticosteroids often causes serious side effects such as growth retardation, glaucoma, hormonal disturbance, peptic ulcer, liver dysfunction and psychologic problems. Alternative treatment for active UC may be necessary to avoid the clinical problems associated with corticosteroid therapy. In recent years, leukocytapheresis (LCAP) and granulocytapheresis (GCAP) using a leukocyte removal filter has been found effective in some cases of adults with inflammatory bowel disease (2,3). However, there have been few reports concerning the efficacy of LCAP and GCAP for UC in childhood (4).We report two children with severe steroid-dependent UC in whom LCAP with leukocyte removal filter was used in treatment. LCAP therapy was safe and effective in two children with refractory UC and allowed discontinuation of corticosteroid therapy with an improvement in quality of life. Prospective studies of this therapy will be needed to clarify the role of LCAP in treatment of childhood UC.
Evidencia científica
Experience with granulocytapheresis in Crohn’s disease
Cuenca, F & Paredes, J & Mendoza, J & Cruz, D & Herrero, A & Díaz-Rubio, M.Revista española de enfermedades digestivas : organo oficial de la Sociedad Española de Patología Digestiva .2004,96. 501-3, 504. DOI:10.4321/S1130-01082004000700007.
Objective: To describe our experience with granulocyte apheresis to induce remission in patients with active Crohn’s disease refractory to conventional treatment. We summarize the results previously obtained with this technique.
Conclusions: Granulocyte apheresis is a safe and well tolerated therapeutic modality that can be a valid therapeutic alternative in the induction of remission in inflammatory bowel disease, although controlled clinical trials must be conducted to define long-term efficacy, as well as to establish «optimal patient» selection, re-treatment interval, and number of sessions.
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