Comparison of the efficacy of granulocyte and monocyte/macrophage adsorptive apheresis and leukocytapheresis in active ulcerative colitis patients: a prospective randomized study.
BACKGROUND
Ulcerative colitis (UC) is a chronic inflammatory bowel disease associated with recurring inflammation of the colorectal mucosa. Recently, cytapheresis has emerged as a new treatment for patients with UC. Removal methods are mainly performed with beads [granulocyte and monocyte/macrophage adsorptive apheresis (GMCAP)] or filters [leukocytapheresis (LCAP)]. Both treatments have been reported to be effective for active UC. There have been few trials, however, comparing the efficacy of GMCAP and LCAP. In this study, we prospectively evaluated the efficacy of LCAP and GMCAP for the treatment of active UC.


METHODS
Thirty-nine patients [18 male, 21 female; mean age 38.7 years; duration of disease 6 years; clinical activity index (CAI) >6 points] with moderate-to-severe active UC were randomly assigned to the LCAP (n=21) or GMCAP group (n=17). Adacolumn (cellulose acetate beads; Japan Immunoresearch Laboratories, Takasaki, Japan) for GMCAP and Cellsorba EX (polyethylene phthalate fibers; Asahi Medical Co. Ltd, Tokyo, Japan) for LCAP were used for leukocyte removal. Patients received two sessions of cytapheresis in the first week, followed by four weekly administrations. Steroid doses were tapered if patients achieved clinical improvement. When the CAI score had decreased by 5 points or more, the patient was considered to have improved.


RESULTS
Thirteen patients in the GMCAP group and 14 in the LCAP group achieved clinical improvement. No significant difference was found in clinical response and clinical course between LCAP and GMCAP. Hemoglobin levels were significantly decreased immediately after one session of cytapheresis in the LCAP group. No severe adverse effects were observed in any of the patients. No significant differences were observed in any clinical parameters predictive of a response to either LCAP or GMCAP. But in all patients receiving cytapheresis, a high CAI score was a significant risk factor for treatment failure. All of the cytapheresis nonresponders had CAI scores >or=16.


CONCLUSIONS
Both GMCAP and LCAP were effective treatments for active UC. Patients with severe UC and a high CAI score were, however, refractory to treatment.
Sakata
Yasuhisa
Y
Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School, Saga, Japan. sakata-y@koseikan.jp
Iwakiri
Ryuichi
R
Amemori
Sadahiro
S
Yamaguchi
Kanako
K
Fujise
Takehiro
T
Otani
Hibiki
H
Shimoda
Ryo
R
Tsunada
Seiji
S
Sakata
Hiroyuki
H
Ikeda
Yuji
Y
Ando
Takashi
T
Nakafusa
Yuji
Y
Fujimoto
Kazuma
K
D000327:Adsorption; D000328:Adult; D001772:Blood Cell Count; D003093:Colitis, Ulcerative / Q000097:blood / Q000628:therapy*; D016238:Cytapheresis / Q000379:methods*; D005260:Female; D006098:Granulocytes; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007937:Leukapheresis / Q000379:methods; D008264:Macrophages; D008297:Male; D008875:Middle Aged; D009000:Monocytes; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
D006454:Hemoglobins