Granulocyte, monocyte/macrophage apheresis for inflammatory bowel disease: the first 100 patients treated in Scandinavia.
OBJECTIVE
Selective leukocyte apheresis is a new type of non-pharmacological treatment for patients with active ulcerative colitis and Crohn's disease. Preliminary data have indicated that this type of therapy is safe and efficacious, and large sham-controlled studies are currently in progress. In Scandinavia, a substantial number of patients with chronic inflammatory bowel disease have already received leukocyte apheresis on a compassionate use basis and the aim of this study was to report the clinical outcome and adverse events in the first patients treated.


METHODS
Clinical details of the first consecutive 100 patients with inflammatory bowel disease treated with granulocyte, monocyte/macrophage (Adacolumn) apheresis in Scandinavia were prospectively registered. Median length of follow-up was 17 months, (range 5-30).


RESULTS
The study population comprised 52 patients with ulcerative colitis, 44 patients with Crohn's disease and 4 patients with indeterminate colitis. In 97 patients the indication for Adacolumn treatment was steroid-refractory or steroid-dependent disease. Clinical remission was attained in 48% of the patients with ulcerative colitis, and an additional 27% had a clinical response to the apheresis treatment. The corresponding figures for patients with Crohn's disease were 41% and 23%, respectively. Complete steroid withdrawal was achieved in 27 out of the 50 patients taking corticosteroids at baseline. Adverse events were reported in 15 patients and headache was most frequently reported (n=7).


CONCLUSIONS
Granulocyte, monocyte/macrophage apheresis treatment seems to be a valuable adjuvant therapy in selected patients with refractory inflammatory bowel disease. The risk for toxicity or severe adverse events appears to be low.
Ljung
Tryggve
T
Department of Gastroentereology and Hepatology, Karolinska University Hospital, Stockholm, Sweden.
Thomsen
Ole Østergaard
OØ
Vatn
Morten
M
Karlén
Per
P
Karlsen
Lars Norman
LN
Tysk
Curt
C
Nilsson
Stefan U
SU
Kilander
Anders
A
Gillberg
Rolf
R
Grip
Olof
O
Lindgren
Stefan
S
Befrits
Ragnar
R
Löfberg
Robert
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006098:Granulocytes; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000453:epidemiology / Q000628:therapy*; D007937:Leukapheresis / Q000379:methods*; D008264:Macrophages; D008297:Male; D008875:Middle Aged; D009000:Monocytes; D011446:Prospective Studies; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology; D016896:Treatment Outcome