Extracorporeal photopheresis (ECP) could be a promising approach to combat steroid dependency in patients with Crohn's disease, according to new findings published in Inflammatory Bowel Diseases.
Corticosteroids are an effective treatment for Crohn's disease, but a number of patients experience recurrent symptoms as the corticosteroid dose is tapered or withdrawn, and can become dependent on these drugs.
ECP promotes a tolerogenic response and this treatment has previously been shown to have a steroid-sparing effect in steroid-dependent patients with Crohn's disease. The procedure is split into three basic stages: leukapheresis (whereby blood leukocytes are treated ex vivo with the photoactivable drug 8-methoxypsoralen); photoactivation (to induce apoptosis and, ultimately, production of regulatory T cells); and reinfusion.
In this open-label, multicentre study, the researchers enrolled 31 steroid-dependent patients with established Crohn's disease (baseline corticosteroid dose ≤40 mg). Individuals received ECP for 24 weeks during which time the dose of steroids was tapered. Patients then went on to receive a further 24 weeks of ECP during the maintenance period.
After 24 weeks, 22.6% of patients had discontinued corticosteroids. Moreover, in those still taking corticosteroids, 64.5% had reduced the dose by half. By 48 weeks, three patients had achieved steroid-free remission.
“ECP may be useful in permitting steroid withdrawal in selected steroid-dependent Crohn's disease patients,” write the authors. Further prospective, randomized, sham-controlled trials are needed to confirm these findings.
ORIGINAL RESEARCH PAPER
Reinisch, W. et al. Extracorporeal photopheresis (ECP) in patients with steroid-dependent Crohn's disease: an open-label, multicenter, prospective trial. Inflamm. Bowel Dis. doi:10.1002/ibd.23012
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Ray, K. Lighting the way for steroid withdrawal in Crohn's disease. Nat Rev Gastroenterol Hepatol 9, 366 (2012). https://doi.org/10.1038/nrgastro.2012.109
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DOI: https://doi.org/10.1038/nrgastro.2012.109