Extracorporeal photopheresis for the treatment of refractory Crohn's disease: results of an open-label pilot study.
BACKGROUND
Extracorporeal photopheresis (ECP) is effective in immune-mediated disorders. A prospective, uncontrolled pilot study was conducted to evaluate the safety and efficacy of ECP in patients with active Crohn's disease (CD) who were refractory to or intolerant of immunosuppressants and/or anti-TNF therapies.


METHODS
Patients with moderate-to-severely active CD (Crohn's Disease Activity Index [CDAI] 220-450 points) underwent 12 weeks of ECP treatment (Weeks 1-4: twice weekly, every week; Weeks 5-12: twice weekly, every other week). Clinical response was defined as a decrease in the CDAI of >or=100 points or remission (CDAI <150 points) at Week 12. Patients who responded at Week 12 could receive an additional 12 weeks of ECP treatment (twice weekly, every other week) in an extension study.


RESULTS
Twenty-eight patients were enrolled with a mean baseline CDAI score of 314 (range 207-457). At Week 12, 14 patients (50%) responded; 13 patients responded within 6 weeks. Seven patients (25%) attained remission by Week 12. Three of 5 patients with open fistulae at baseline had fistula closure. Response was similar among patients naïve to anti-TNF agents and patients who had previously been refractory or intolerant to anti-TNF agents. Of the 12 patients who entered the extension study, 9 (75%) maintained their response at Week 24.


CONCLUSIONS
In patients with moderate-to-severely active CD who were refractory to or intolerant of immunosuppressants and/or anti-TNF agents, ECP was well tolerated and induced clinical response (50%) and remission (25%) in patients. Most patients were able to maintain a response with continued treatments.
Abreu
Maria T
MT
University of Miami Miller School of Medicine, Miami, FL 33101-6960, USA. MAbreu1@med.miami.edu
von Tirpitz
Christian
C
Hardi
Robert
R
Kaatz
Martin
M
Van Assche
Gert
G
Rutgeerts
Paul
P
Bisaccia
Emil
E
Goerdt
Sergi
S
Hanauer
Stephen
S
Knobler
Robert
R
Mannon
Peter
P
Mayer
Lloyd
L
Ochsenkuhn
Thomas
T
Sandborn
William J
WJ
Parenti
Dennis
D
Lee
Kevin
K
Reinisch
Walter
W
D000328:Adult; D002097:C-Reactive Protein / Q000378:metabolism; D003424:Crohn Disease / Q000188:drug therapy* / Q000276:immunology; D016154:Digestive System Fistula / Q000188:drug therapy; D004351:Drug Resistance; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008297:Male; D008730:Methoxsalen / Q000627:therapeutic use; D008875:Middle Aged; D017893:Photopheresis / Q000009:adverse effects / Q000379:methods*; D017319:Photosensitizing Agents / Q000627:therapeutic use; D010865:Pilot Projects; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D055815:Young Adult
D007166:Immunosuppressive Agents; D017319:Photosensitizing Agents; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; D008730:Methoxsalen