Granulocyte-monocyte adsorptive apheresis in pediatric inflammatory bowel disease: results, practical issues, safety, and future perspectives.
BACKGROUND
The purpose of the study was to collect data on granulocyte-monocyte adsorptive apheresis (GMA) for the treatment of corticosteroid-dependent (SD) or corticosteroid-resistant (SR) inflammatory bowel disease (IBD) in children from 3 Nordic countries to evaluate its efficacy and safety and to assess practical issues.


METHODS
Retrospective data on 37 children treated with GMA were collected. In all, 22 children had ulcerative colitis (UC), 13 Crohn's disease (CD), and 2 had indeterminate colitis (IC). Their mean age was 13.2 years, range 5-17 years, and mean duration of disease was 2.4 years, range 1 month to 6 years. Indication for treatment in the UC group was SD in 11 cases, SR in 6 cases, and other reasons in 5 cases. The corresponding numbers in the CD group were SD in 8 cases, SR in 2 cases, and other reasons in 3 cases. In the IC group, 1 had SD and 1 was refractory to steroids, azathioprine, and infliximab. Efficacy was evaluated by severity indices: the Pediatric Ulcerative Colitis Activity Index (PUCAI) and the Pediatric Crohn's Disease Activity Index (PCDAI) and tapering of corticosteroids.


RESULTS
PUCAI and PCDAI decreased significantly in both groups after 3 months (P = 0.0007, P = 0.025). The dosage of corticosteroid was significantly reduced in the UC group by the end of GMA (P = 0.004) and this response continued after 3 months. Relapse was seen in 2 patients with UC and 3 patients with CD after 3 months follow-up.


CONCLUSIONS
GMA seems to be an effective and safe treatment in 81% of the SD or SR pediatric IBD patients, especially in those with UC.
Ruuska
T
T
Department of Paediatrics, Tampere University Hospital, Finland. tarja.ruuska@pshp.fi.
Wewer
V
V
Lindgren
F
F
Malmborg
P
P
Lindquist
M
M
Marthinsen
L
L
Browaldh
L
L
Casswall
T
T
Kalliomäki
M
M
Grönlund
J
J
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001781:Blood Component Removal / Q000009:adverse effects / Q000379:methods*; D002648:Child; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000276:immunology* / Q000628:therapy*; D003131:Combined Modality Therapy; D003424:Crohn Disease / Q000188:drug therapy / Q000276:immunology* / Q000628:therapy*; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D006098:Granulocytes; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D009000:Monocytes; D010349:Patient Compliance; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies
D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents