Safety and efficacy of granulocyte and monocyte adsorption apheresis in paediatric inflammatory bowel disease: a prospective pilot study.
OBJECTIVE
Selective granulocyte-monocyte adsorption (GMA) apheresis is a safe technique that has shown efficacy in inflammatory bowel disease (IBD), especially in adult steroid-dependent and steroid-refractory ulcerative colitis. GMA apheresis is performed with Adacolumn, a direct blood perfusion system that selectively adsorbs circulating granulocytes and monocytes. Studies on efficacy of GMA apheresis in paediatric IBD are scarce. Our aim was to evaluate efficacy, safety, and tolerability of GMA apheresis in paediatric IBD patients followed for 1 year.


METHODS
Nine patients with a mild to moderate flare-up (6 boys, 3 girls; 5 ulcerative colitis [UC], 4 Crohn disease [CD]) were included. Mean age at inclusion was 13 years and 9 months, and mean disease duration before inclusion was 28 months. All of our patients with UC were steroid-dependent; patients with CD had been unsuccessfully treated with other therapies. GMA apheresis consisted of 5 consecutive weekly sessions lasting 60 minutes each.


RESULTS
After the 5 sessions, 4 of 5 patients with UC and 1 of 4 patients with CD achieved remission. This remission was maintained in 2 of 4 patients with UC and in the single patients with CD. Patients taking steroids could begin to taper their daily doses after the second apheresis, and 3 of 5 of these patients reached the end of the study steroid-free. GMA apheresis was well tolerated and no severe side effects related to the technique were observed.


CONCLUSIONS
GMA apheresis is a safe, well-tolerated technique in paediatric IBD. As previously reported, we have observed a better efficacy in promoting and maintaining remission, and reducing conventional drugs in patients with UC than in patients with CD.
Martín de Carpi
Javier
J
Department of Paediatric Gastroenterology, Hepatology, and Nutrition, Hospital Sant Joan de Déu, Barcelona, Spain. javiermartin@hsjdbcn.org
Vilar
Pere
P
Prieto
Gerardo
G
García Novo
María Dolores
MD
Ribes
Carmen
C
Varea
Vicente
V
D000293:Adolescent; D000327:Adsorption; D000893:Anti-Inflammatory Agents / Q000494:pharmacology; D002648:Child; D003093:Colitis, Ulcerative / Q000473:pathology / Q000628:therapy*; D003424:Crohn Disease / Q000473:pathology / Q000628:therapy*; D004351:Drug Resistance; D005260:Female; D006098:Granulocytes; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D007937:Leukapheresis / Q000379:methods*; D008297:Male; D009000:Monocytes; D010865:Pilot Projects; D011446:Prospective Studies; D012074:Remission Induction; D012449:Safety; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents