Effectiveness of Cytapheresis for Ulcerative Colitis in Special Situations: Delayed Onset of Optimum Efficacy in Elderly Patients.
Effectiveness of Cytapheresis for Ulcerative Colitis in Special Situations: Delayed Onset of Optimum Efficacy in Elderly Patients.
复制标题
特殊情况下细胞去除术对溃疡性结肠炎的有效性：老年患者最佳疗效的延迟出现。
作者：
Shibuya T;Nomura O;Nomura K;Okahara K;Haga K;Ishikawa D;Sakamoto N;Ogihara T;Osada T;Nagahara A.
背景：细胞清除术是一种非药物治疗选择，其中已知通过释放炎症细胞因子来消耗升高/活化的白细胞，从而加剧和延续溃疡性结肠炎（UC）。因此，对于希望避免使用药物的老年患者，这是一种相关的治疗方法。方法：回顾性分析我院72例活动性UC行细胞穿刺诱导缓解的疗效。患者包括11例老年患者，类固醇、生物制剂、钙调神经磷酸酶抑制剂患者和13例肠道外并发症患者。Lichtiger UC临床活动指数≤4意味着在治疗结束时评估缓解，然后在1个月后评估缓解。肠道外表现的改善意味着主要发病率的改善。结果：老年患者治疗结束时缓解率为36.4%，非老年患者缓解率为54.2%。采卵后1个月，老年人的缓解率为72.7% (p= 0.042)，而非老年人的缓解率为58.3%，说明老年人存在延迟反应现象。Cytapheresis治疗4例生物制剂无应答患者的有效率为75%，13例肠外并发症患者的有效率为84.6%，对皮炎和关节痛的疗效显著。结论：与药物不同，红细胞分离术的疗效是有时间依赖性的。因此，在老年人中，我们观察到延迟反应，表明老年患者可能在红细胞分离治疗结束后仍有反应。因此，在红细胞分离治疗结束时未显示疗效的患者应进行延迟反应随访。此外，Cytapheresis因其良好的安全性而受到患者的青睐。
Background:Cytapheresis is a non-pharmacologic treatment option in which depleting elevated/activated leucocytes is known to exacerbate and perpetuate ulcerative colitis (UC) by releasing inflammatory cytokines. Therefore, it is a relevant treatment for elderly patients who wish to avoid pharmacologicals.Methods:The efficacy of Cytapheresis for remission induction in 72 patients who received Cytapheresis for active UC at our hospital was retrospectively evaluated. Patients included 11 elderly cases, patients on steroids, biologics, calcineurin inhibitor, and 13 with extra-intestinal complications. Lichtiger’s UC clinical activity index ≤4 meant remission was assessed at the end of therapy and then 1 month later. The efficacy on extra-intestinal manifestations meant improvement of the main morbidity.Results:At the end of Cytapheresis therapy, the remission rate in the elderly was 36.4%, and 54.2% in the non-elderly patients. One-month post Cytapheresis, the remission rate in the elderly had increased to 72.7% (p= 0.042), but to 58.3% in the non-elderly, suggesting a delayed response phenomenon in the elderly. The efficacy of Cytapheresis in 4 cases with loss of response to biologics was 75%, and 84.6% in the 13 patients with extra-intestinal complications, indicating a dramatic efficacy on dermatitis and arthralgia.Conclusions:Unlike pharmacologicals, the efficacy of Cytapheresis appears to be time dependent. Accordingly, in the elderly, we observed a delayed response, indicating that elderly patients may respond beyond the end of Cytapheresis therapy. Therefore, patients who do not show efficacy at the end of Cytapheresis therapy should be followed up for delayed response. Further, Cytapheresis is favored by patients for its good safety profile.