Granulocyte and monocyte adsorptive apheresis in the treatment of active distal ulcerative colitis: a prospective, pilot study.
OBJECTIVE
To assess safety and clinical efficacy of granulocyte and monocyte adsorptive apheresis for distal ulcerative colitis.


METHODS
Granulocyte and monocyte adsorptive apheresis therapy (five aphereses for 5 consecutive weeks) was performed for 30 consecutive patients with active distal ulcerative colitis. Patient compliance, adverse effects and clinical symptoms were regularly assessed.


RESULTS
Adverse effects were noted during nine (6%) apheresis sessions in eight patients; slight headache five, transient abdominal pain with tenesmus two, fever (38 degrees C) one and mild liver dysfunction one. None of these adverse effects was serious and all patients could complete five aphereses. Clinical symptoms (stool frequency and consistency, rectal bleeding, tenesmus and mucus in stools) significantly improved after the third apheresis. Clinical remission (normal stool frequency and no rectal bleeding) was achieved in 21 patients (70%) after five aphereses. The median Disease Activity Index score significantly decreased; from 6 [interquartile range (IQR): 4-7] to 2 (IQR: 1-3) (P < 0.0001).


CONCLUSIONS
In the treatment of active distal ulcerative colitis, granulocyte and monocyte adsorptive apheresis is safe and well-tolerated. Granulocyte and monocyte adsorptive apheresis had a beneficial effect on clinical remission and symptoms. However, randomized-controlled trials would be necessary to assess a definite efficacy of granulocyte and monocyte adsorptive apheresis.
Yamamoto
T
T
Inflammatory Bowel Disease Centre, Yokkaichi Social Insurance Hospital, Yokkaichi, Mie, Japan. nao-taka@sannet.ne.jp
Umegae
S
S
Kitagawa
T
T
Yasuda
Y
Y
Yamada
Y
Y
Takahashi
D
D
Mukumoto
M
M
Nishimura
N
N
Yasue
K
K
Matsumoto
K
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D003093:Colitis, Ulcerative / Q000473:pathology / Q000628:therapy*; D016238:Cytapheresis / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006098:Granulocytes; D006801:Humans; D008297:Male; D008875:Middle Aged; D009000:Monocytes; D010349:Patient Compliance; D010865:Pilot Projects; D011446:Prospective Studies; D016896:Treatment Outcome