At present, UC in the majority of affected patients (approximately 70%) follows a clinical course that is either remitting-relapsing or chronic continuous. Therefore, an ideal treatment is one that has sustainable efficacy. UC is also classified by the disease location (proctitis, left-sided or total colitis) and by severity (mild, moderate, severe or fulminant), with several classifications provided by combining these categories. Regarding treatment of UC, several issues have presented challenges to IBD physicians, including the use of corticosteroids to induce remission, what should be used as maintenance therapy in patients who respond to steroids and what to do with patients who do not respond to steroids. This article introduces selective leucocytapheresis with an Adacolumn as a new therapeutic strategy for patients with UC.

First - choice Medication for Inducing Remission
To induce remission of mild or moderate UC, aminosalicylates are commonly used. This choice presents no problem in patients experiencing their first attack of UC. When flare-ups reoccur, however, treatment should be provided on a case-by-case basis. It is necessary to consider the patient’s medical history, past drug therapy and response to a given drug. For example, in patients with recurring flareups who have become steroid-dependent or steroidrefractory, simply increasing the dosage of 5-ASA may not be sufficient, even when symptoms are not particularly severe.

The questions are whether the steroid dose should be increased and if another drug is to be added, what the new drug should be. In view of the fact that chronic steroid administration is associated with serious adverse drug reaction (ADR), long-term steroid use should not be adopted. There is a need for a drug that can be used in addition to or instead of a steroid.