Adsorptive granulocyte and monocyte apheresis versus prednisolone in patients with corticosteroid-dependent moderately severe ulcerative colitis.
OBJECTIVE
Active ulcerative colitis (UC) is often associated with increased peripheral granulocytes and monocytes/macrophages which show activation behavior and prolonged survival time. Further, mucosal granulocyte level parallels intestinal inflammation and can predict UC relapse. Accordingly, our aim was to see if adsorptive granulocyte/monocyte apheresis (GMA) can promote remission and spare steroid in patients with steroid-dependent (SD) UC.


METHODS
69 SD patients, at the time of relapse, were randomly assigned to groups I (n = 46) and II (n = 23). The mean dose of prednisolone (PSL) was 12 mg/day/patient, CAI (clinical activity index) 9.2 in both groups. Group I patients were given up to 11 GMA sessions over 10 weeks with Adacolumn; in group II, the mean dose of PSL was increased to 30 mg/day/patient.


RESULTS
At week 12, 83% of group I and 65% of group II patients were in remission, CAI in group I was 1.7 (p < 0.001) and in group II, 2.5 (p < 0.001). Further, during the 12 weeks of treatment, the cumulative amount of PSL received per patient was 1,157 mg in group I and 1,938 mg in group II (p = 0.001).


CONCLUSIONS
GMA appeared to be an effective adjunct to standard drug therapy of moderately severe UC by promoting remission and sparing steroids.
Department of Medicine, Hamamatsu University, Hamamatsu, Japan. hanai@hama-med.ac.jp
Hiroyuki
H
Hanai
Fumitoshi
F
Watanabe
Masami
M
Yamada
Yoshihiko
Y
Sato
Ken
K
Takeuchi
Takayuki
T
Iida
Kotaro
K
Tozawa
Tatsuo
T
Tanaka
Yasushi
Y
Maruyama
Isao
I
Matsushita
Yasushi
Y
Iwaoka
Kazuto
K
Kikuch
Abby R
AR
Saniabadi
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001781:Blood Component Removal; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000276:immunology*; D005260:Female; D006098:Granulocytes; D006801:Humans; D007167:Immunotherapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009000:Monocytes; D011239:Prednisolone / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D011239:Prednisolone