title: Comparison of the efficacy of granulocyte and monocyte/macrophage adsorptive apheresis and leukocytapheresis in active ulcerative colitis patients: a prospective randomized study.
abstract: 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.
authors.affiliation: Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School, Saga, Japan. sakata-y@koseikan.jp
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Sakata
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Iwakiri
authors.forename: Sadahiro
authors.initials: S
authors.lastname: Amemori
authors.forename: Kanako
authors.initials: K
authors.lastname: Yamaguchi
authors.forename: Takehiro
authors.initials: T
authors.lastname: Fujise
authors.forename: Hibiki
authors.initials: H
authors.lastname: Otani
authors.forename: Ryo
authors.initials: R
authors.lastname: Shimoda
authors.forename: Seiji
authors.initials: S
authors.lastname: Tsunada
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sakata
authors.forename: Yuji
authors.initials: Y
authors.lastname: Ikeda
authors.forename: Takashi
authors.initials: T
authors.lastname: Ando
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nakafusa
authors.forename: Kazuma
authors.initials: K
authors.lastname: Fujimoto
mesh_terms: 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
chemical_list: D006454:Hemoglobins