Granulocytapheresis is useful as an alternative therapy in patients with steroid-refractory or -dependent ulcerative colitis.
BACKGROUND
Recently, granulocyte and monocyte adsorption apheresis (GCAP) has been shown to be safe and effective for active ulcerative colitis (UC). We analyzed the safety and efficacy of GCAP (G-1 Adacolumn) in patients with steroid-refractory and -dependent UC. G-1 Adacolumn is filled with cellulose acetate carriers that selectively adsorb granulocytes and monocytes/macrophages.


METHODS
Forty-four patients with UC were treated with GCAP. These patients received 5 apheresis sessions over 4 weeks. Twenty patients had steroid-refractory UC (group 1) and 10 had steroid-dependent UC (group 2). Fourteen patients who did not want readministration of steroids were treated with GCAP at the time of relapse, just after discontinuation of steroid therapy (group 3).


RESULTS
Of 44 patients treated with GCAP, 24 (55%) obtained remission (CAI < or = 4), 9 (20%) showed a clinical response, and 11 (25%) remained unchanged. Only 2 of 10 patients (20%) with severe steroid-refractory UC (CAI > or = 12) achieved remission, whereas 7 of 10 patients (70%) with moderate steroid-refractory UC achieved remission (p < 0.05). The dose of corticosteroids was tapered in 9 of 10 (90%) patients with steroid-dependent UC after GCAP therapy. Twelve (86%) of 14 patients in group 3 showed an improvement in symptoms and could avoid re-administration of steroids after GCAP. No severe adverse effects occurred.


CONCLUSIONS
The findings of this study suggest that GCAP may be a useful alternative therapy for patients with moderate steroid-refractory or -dependent UC, although cyclosporin A or colectomy is necessary in patients with severe UC. GCAP may also be useful for avoiding re-administration of steroids at the time of relapse. Randomized, controlled clinical trials are needed to confirm these findings.
Department of Internal Medicine, School of Medicine, Keio University, Shinjuku-ku, Tokyo 160-8582, Japan.
Makoto
M
Naganuma
Shinsuke
S
Funakoshi
Atsushi
A
Sakuraba
Hanae
H
Takagi
Nagamu
N
Inoue
Haruhiko
H
Ogata
Yasushi
Y
Iwao
Hiromasa
H
Ishi
Toshifumi
T
Hibi
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D004351:Drug Resistance; D004361:Drug Tolerance; D005260:Female; D006098:Granulocytes; D006801:Humans; D007937:Leukapheresis / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D009000:Monocytes; D012074:Remission Induction; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones