Aféresis leucocitaria en la inducción de la remisión y retirada de corticoides en la colitis ulcerosa corticodependiente

Abstract

Background Active ulcerative colitis (UC) is characterized by infiltration of neutrophils, monocytes and macrophages in the colonic mucosa. Selective depletion of activated leucocytes by apheresis devices can be an effective treatment to achieve remission in UC, particularly when conventional treatment has failed. Objective To evaluate the efficacy and safety of leukapheresis in remission induction and steroid withdrawal in patients with active steroid-dependent UC. Patients and method Thirteen patients with steroid-dependent UC unresponsive to immunomodulatory agents underwent weekly leukapheresis sessions. The steroid dose was tapered down according to clinical response. Four weeks after the final leukapheresis session, clinical remission (as defined by an inactive modified Truelove activity index and complete corticosteroid withdrawal) and endoscopic remission were evaluated. Results Clinical remission was achieved in 7 (54 %) of 13 patients. Overall efficacy, remission or partial response, was achieved in 77 %. Three patients underwent 2 cycles of 5 sessions each. Endoscopic remission was achieved in 38.4 % of the patients. The procedure was well tolerated. However, there was one case of pneumothorax on central venous catheter insertion after failed peripheral cannulation. Conclusions Leukapheresis is a safe and effective therapeutic option for induction of remission and corticosteroid withdrawal in patients with steroid-dependent UC unresponsive to immunomodulatory therapy.