The etiology of UC is believed that an immune abnormality may be involved in its development. Steroid has long been the second line therapy for the induction to remission in UC, if remission cannot be achieved by salazosulfapyridine or mesalazine treatment. However, steroid administration can occur various side effects. LCAP has been reported to be effective for steroid-refractory or steroid-dependent patients with UC; however, the data of LCAP for steroid-naïve patient with UC is limited.
A research article to be published on September 14, 2008 in the World Journal of Gastroenterology addresses this question. The research team led by Dr. Masatoshi Kudo from Kinki University School of Medicine of Japan investigated the therapeutic utility of LCAP for steroid-naïve patient with UC. They also assessed whether the efficacy of LCAP can be predicted on the basis of endoscopic findings.
In 1995, LCAP was introduced for patients with UC. LCAP is a method where the blood is passed though a leukocyte removal filter before being returned to the body. On average, 1.6 × 1010 leukocytes are removed during one session. These leukocytes include granulocytes, lymphocytes and monocytes. Almost 100% of granulocytes and monocytes and 60% of lymphocytes are removed by removal filter. In this study, we found 61.1% of steroid-naive UC patients (11/18) had entered remission eight weeks after the last LCAP session.
Since steroids can induce remission in 45% to 90% of salazosulfapyridine or mesalazine non-responders, it appears that LCAP is as efficacious as steroids as a second-line treatment. Analysis of the endoscopic findings of the patients revealed that while the remission rate of the patients with erosion was extremely high after LCAP; however, that of the patients with geographic ulcers and deep ulcers extremely low. None of the patients experienced any severe adverse effects from LCAP. Given the low rate of adverse events suffered by patients treated with LCAP, we propose that patients with moderately active UC should be treated with LCAP before steroids are considered.
In conclusion, LCAP is a useful and safe therapy for steroid-naive UC patients with moderate activity. Moreover, endoscopic findings help to predict the efficacy of this treatment.