Adsorptive granulocyte and monocyte apheresis for refractory Crohn's disease: an open multicenter prospective study.
BACKGROUND
Active Crohn's disease (CD) is often associated with elevated levels of platelets, granulocytes, and monocytes that are activated and resistant to apoptosis. The level of neutrophils in the intestinal mucosa has been quantitatively related to the severity of intestinal inflammation in CD. We postulated that patients with CD that is refractory to conventional medications might respond to a reduction of granulocytes and monocytes by adsorptive apheresis.


METHODS
Twenty-one patients with a CD activity index (CDAI) of 200-399 and unresponsive to standard medication, which included nutritional intervention, received granulocyte and monocyte adsorptive apheresis (GCAP) as an adjunct to their ongoing medication. GCAP was performed with an Adacolumn, which adsorbs granulocytes, monocytes, and a small fraction of lymphocytes (FcgammaR and complement receptor-bearing leucocytes). Patients received one GCAP session/week for 5 consecutive weeks. CDAI, International Organization for the Study of Inflammatory Bowel Disease (IOIBD), and IBD questionnaire (IBDQ) scores were evaluated.


RESULTS
During the initial conventional/nutritional therapy, no significant improvement was seen in any patient. However, at week 7 of GCAP therapy, significant improvements in CDAI, IOIBD, and IBDQ scores were observed. The CDAI, IOIBD, and IBDQ scores before GCAP were 275.6+/-54.2, 3.4+/-1.4, and 152+/-22, respectively. The corresponding values after GCAP were 214.8+/-89.2 (P=0.0005), 2.54+/-1.5 (P=0.0224), and 165+/-29 (P=0.0327), respectively.


CONCLUSIONS
GCAP could be effective for inducing remission and improving quality of life in patients with active CD that is refractory to conventional therapy.
Fukuda
Yoshihiro
Y
Department of Gastroenterology, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, 663-8501, Japan.
Matsui
Toshiyuki
T
Suzuki
Yasuo
Y
Kanke
Kazunari
K
Matsumoto
Takayuki
T
Takazoe
Masakazu
M
Matsumoto
Takayuki
T
Motoya
Satoshi
S
Honma
Terasu
T
Sawada
Koji
K
Yao
Tsuneyoshi
T
Shimoyama
Takashi
T
Hibi
Toshifumi
T
D000293:Adolescent; D000328:Adult; D001781:Blood Component Removal / Q000379:methods*; D002648:Child; D003424:Crohn Disease / Q000628:therapy*; D005260:Female; D006098:Granulocytes; D006801:Humans; D008297:Male; D008875:Middle Aged; D009000:Monocytes; D011446:Prospective Studies; D016896:Treatment Outcome