title: Therapeutic effect of intensive granulocyte and monocyte adsorption apheresis combined with thiopurines for steroid- and biologics-naïve Japanese patients with early-diagnosed Crohn's disease.
abstract: BACKGROUND
  Early induction with biologics can reduce complications in patients with Crohn's disease (CD) and improve their quality of life. The safety of biologics, however, is uncertain. Granulocyte and monocyte adsorptive apheresis (GMAA) is a natural biologic therapy that selectively removes granulocytes and monocytes/macrophages and has few severe adverse effects. The effects of GMAA on patients with early-diagnosed CD are unclear. We investigated the effects of GMAA combined with thiopurines on patients with early-diagnosed CD.
  
  
  METHODS
  Twenty-two corticosteroid- and biologic-naïve patients with active early-diagnosed CD were treated with intensive GMAA (twice per week) combined with thiopurines administration. Active early-diagnosed CD was defined as follows: (i) within 2years after diagnosis of CD, (ii) with no history of both surgical treatment and endoscopic dilation therapy, and (iii) Crohn's Disease Activity Index (CDAI) was higher than 200. We investigated the ratios of clinical remission defined as CDAI was less than or equal to 150 at 2, 4, 6 and 52weeks and mucosal healing defined as a Simplified Endoscopic Activity Score for Crohn's Disease (SES-CD) as 0 at 6 and 52weeks. Adverse events were recorded at each visit.
  
  
  RESULTS
  The ratios of clinical remission at 2, 4, and 6 weeks were 6 of 22 (27.2%), 12 of 22 (54.5%), and 17 of 22 (77.2%), respectively. At 52 weeks, 18 of 21 patients (81.8%) were in clinical remission. The ratios of mucosal healing at 6 and 52 weeks were 5 of 22 (22.7%) and 11 of 22 (50%), respectively. The difference in the mucosal healing ratio was significant between 6 and 52 weeks (p = 0.044). No serious adverse effects were observed during this study.
  
  
  CONCLUSIONS
  Combination therapy with intensive GMAA and thiopurines administration rapidly induced high remission in patients with active early-diagnosed CD without serious adverse effect. Mucosal healing was observed in 50.0% of enrolled patients. This combination therapy might be a rational option for patients with early-diagnosed CD.
authors.forename: Takumi
authors.initials: T
authors.lastname: Fukuchi
authors.affiliation: Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University Hospital, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan. hiropy_n@kuhp.kyoto-u.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakase
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ubukata
authors.forename: Minoru
authors.initials: M
authors.lastname: Matsuura
authors.forename: Takuya
authors.initials: T
authors.lastname: Yoshino
authors.forename: Takahiko
authors.initials: T
authors.lastname: Toyonaga
authors.forename: Keiji
authors.initials: K
authors.lastname: Shimazu
authors.forename: Hideaki
authors.initials: H
authors.lastname: Koga
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamashita
authors.forename: Dai
authors.initials: D
authors.lastname: Ito
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Ashida
mesh_terms: D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use*; D001781:Blood Component Removal / Q000379:methods*; D003424:Crohn Disease / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D042241:Early Diagnosis; D006098:Granulocytes; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007413:Intestinal Mucosa / Q000473:pathology; D008264:Macrophages; D009000:Monocytes; D011446:Prospective Studies; D012074:Remission Induction
chemical_list: D007166:Immunosuppressive Agents; D001379:Azathioprine