Long-term clinical impact of early introduction of granulocyte and monocyte adsorptive apheresis in new onset, moderately active, extensive ulcerative colitis

• Published in: Journal of Crohn's and colitis 2012-08, Vol.6 (7), p.750-755
• Main Authors: Yamamoto, Takayuki, Umegae, Satoru, Matsumoto, Koichi
• Format: Article
• Language: English
• Subjects: Adult; Anti-Inflammatory Agents - administration & dosage; Anti-Inflammatory Agents - therapeutic use; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Colitis, Ulcerative - blood; Colitis, Ulcerative - therapy; Corticosteroid; Female; Granulocyte and monocyte adsorptive apheresis; Granulocytes; Humans; Kaplan-Meier Estimate; Leukapheresis; Longitudinal Studies; Male; Mesalamine - therapeutic use; Monocytes; Prednisone - administration & dosage; Prednisone - therapeutic use; Recurrence; Remission Induction; Retrospective Studies; Severity of Illness Index; Steroid-dependency; Substance-Related Disorders - etiology; Sulfasalazine - therapeutic use; Treatment Outcome; Ulcerative colitis
• ISSN: 1873-9946; 1876-4479
• DOI: 10.1016/j.crohns.2011.12.009

The efficacy of granulocyte and monocyte adsorptive apheresis (GMA) for patients with a first episode of ulcerative colitis (UC) has been scarcely reported. This study was to see if the introduction of GMA at an early stage reduces corticosteroid administration and steroid dependency in the long term clinical course of UC. Forty consecutive patients with moderately active symptoms as the first attack of UC were included. Twenty patients were treated with GMA, with or without corticosteroids (GMA group), and the other 20 were given corticosteroids without GMA (steroid group). All patients were monitored for 5years. Relapses were treated in the same manner as the first attack in both groups. The total dose of steroid administered and the appearance of steroid-dependency were to be compared between the two groups. All patients in both groups achieved clinical remission after the first attack. The mean number of relapses per patient was 2.8 in the GMA group and 2.9 in the steroid group (P=0.86). During this study, 5 patients in the GMA group did not require corticosteroids. The mean dose of steroid administered during the 5years was 2141mg in the GMA group vs 5443mg in the steroid group (P=0.002). One patient in the GMA group and 7 in the steroid group were steroid-dependent at the end of the study (P=0.048). In patients with the first UC episode, GMA therapy at an early stage significantly reduces steroid administration and steroid-dependency in the long-term clinical course.