Digestive and Liver Disease 42 (2010) 432–435 Contents lists available at ScienceDirect Digestive and Liver Disease journal homepage: www.elsevier.com/locate/dld Alimentary Tract Sustained remission after steroids and leukocytapheresis induced response in steroid-dependent ulcerative colitis: Results at 1 year Jose L. Cabriada a,∗ , Nora Ibargoyen a,b , Anaiansi Hernández a , Antonio Bernal a , Agustín Castiella c a Gastroenterology and Hepatology Service, Hospital Galdakao-Usánsolo, Galdakao (Vizcaya), Spain b Basque Office for Health Technology Assessment, (Osteba) Vitoria, Spain c Gastroenterology–Hepatology Unit, Hospital Mendaro (Guipúzcoa), Spain article info Article history: Received 8 February 2009 Accepted 9 September 2009 Available online 14 October 2009 Keywords: Leukocytapheresis Steroid-dependent Steroids free sustained remission Ulcerative colitis abstract Background: Leukocytapheresis (LAP) could be an alternative treatment for steroid-dependent ulcerative colitis (UC). Aims: To assess the duration of response at 1 year after this treatment. Patients and methods: A prospective study in 18 patients with steroid-dependent UC treated with LAP plus steroids after failure or intolerance to immunomodulators. Clinical and endoscopic (Mayo Clinic index) examinations were performed at 1 month after the last apheresis and at 12 months. The clinical, endoscopic remission and the relapse during the 1-year follow-up were evaluated based on standard parameters. Results: Induction of remission: clinical remission: 10/18 (55%). Partial response: 4. Endoscopic remission: 9 (50%), always accompanied by clinical remission. A significant correlation was observed between clin- ical remission and endoscopic remission (r s = 0.894; p ≤ 0.001). At 1 year: sustained steroid-free clinical remission in 9 (50%), all of whom presented initial endoscopic remission. Remission and relapse before 1 year in 17%. A tendency for sustained remission at 1 year was observed when initial endoscopic remission was achieved. Conclusions: Initial remission can be maintained at 1 year in half of the patients without the need for additional steroids. Complete remission and endoscopic mucosal healing is proposed as an objective for achieving a lasting response. © 2009 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved. 1. Introduction Ulcerative colitis (UC) and Crohn’s Disease (CD) are chronic inflammatory bowel diseases (IBD) which are characterised by their recurrent nature. Systemic steroids are currently still the best way of inducing remission in moderate to severe episodes, although it has been found that 29% of patients required surgery and 22% developed steroid-dependent UC at 1 year after steroid treatment [1]. In the latter case, the therapeutic objective should be a complete withdrawal of steroids in order to avoid their long- term side-effects [2]. Thiopurine-type immunomodulators and biological infliximab-based treatments are effective in maintaining remission in the absence of steroids when conventional treatment fails [3,4], although a significant number of patients can lose this response or are intolerant to these treatments [5,6]. Other alter- ∗ Corresponding author at: Dept Gastroenterology–Hepatology, 8th Floor, Hospi- tal de Galdakao-Usánsolo, B ◦ Labeaga s/n, 48 960 Galdakao, Vizcaya, Spain. Tel.: +34 94 4007004; fax: +34 94 4007132. E-mail address: jcabriada@gmail.com (J.L. Cabriada). native treatments are therefore required that allow remission to be maintained in the long term and the course of the steroid- dependent disease to be modified, thereby delaying or preventing the need for colectomy. UC activity is associated with an increase in activated granu- locytes and monocytes-macrophages in peripheral blood and the colonic mucosa, where they are a major cause of tissue damage [7]. Indeed, the extent of mucosal infiltration by neutrophils has been qualitatively linked to the severity of symptoms and the like- lihood of relapse [8]. Granulocytes and monocytes-macrophages are therefore potential therapeutic targets for the treatment of IBD and other autoimmune diseases. Leukocyte apheresis techniques allow the selective adsorption of various types of circulating activated leukocytes, which are replaced by immature, inactive, CD-10-negative leukocytes [9]. Their ability to migrate to, and infiltrate, tissue is thereby greatly reduced. As well as this mechanism, several studies have detected an immunomodulatory effect and have suggested other possible mechanisms of action, such as a reduction in the production of acti- vated proinflammatory cytokines (IL-1, TNF, IL-6, IL-8) [9,10], an increase in anti-inflammatory mediators (soluble TNF, HGF and 1590-8658/$36.00 © 2009 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.dld.2009.09.001