title: Granulo-monocyto apheresis is more effective in mild ulcerative colitis than in moderate to severe disease.
abstract: OBJECTIVE
  To evaluate whether the effectiveness of Granulo-monocyto apheresis (GMA), a technique that consists of the extracorporeal removal of granulocytes and monocytes from the peripheral blood, might vary according to the severity of ulcerative colitis (UC) in patients with mild to moderate-severe disease UC activity.
  
  
  METHODS
  We retrospectively reviewed prospectively collected data of patients undergoing GMA at our inflammatory bowel disease centre who had at least a 6 mo of follow-up. The demographics, clinical and laboratory data were extracted from the patients' charts and electronic records. The severity of UC was scored according to the Modified Truelove Witts Severity Index (MTWSI). A clinical response was defined as a decrease from baseline of ≥ 2 points or a value of MTWSI ≤ 2 points.
  
  
  RESULTS
  A total of 41 (24 males/17 females; mean age 47 years) patients were included in the study. After GMA cycle completion, 21/28 (75%) of mild UC patients showed a clinical response compared with 7/13 (54%) of patients with moderate to severe disease (P = 0.27). At 6-mo, 14/28 (50%) of the mild UC patients maintained a clinical response compared with 2/13 (15%) of the patients with moderate to severe disease (P = 0.04). After the GMA cycle completion and during the 6-mo follow up period, 13/16 (81%) and 9/16 (56%) of mild UC patients with intolerance, resistance and contraindications to immunosuppressants and/or biologics showed a clinical response compared with 2/6 (33%) and 0/6 (0%) of patients with moderate to severe disease activity with these characteristics (P = 0.05 and P = 0.04, respectively).
  
  
  CONCLUSIONS
  Patients with mild UC benefit from GMA more than patients with moderate to severe disease in the short-term period. GMA should be considered a valid therapeutic option in cases of contraindications to immunosuppressants, corticosteroids and/or biologics.
authors.affiliation: Chiara De Cassan, Edoardo Savarino, Giorgia Hatem, Giacomo Carlo Sturniolo, Renata D'Incà, Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: De Cassan
authors.affiliation: Chiara De Cassan, Edoardo Savarino, Giorgia Hatem, Giacomo Carlo Sturniolo, Renata D'Incà, Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Savarino
authors.affiliation: Chiara De Cassan, Edoardo Savarino, Giorgia Hatem, Giacomo Carlo Sturniolo, Renata D'Incà, Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Marson
authors.affiliation: Chiara De Cassan, Edoardo Savarino, Giorgia Hatem, Giacomo Carlo Sturniolo, Renata D'Incà, Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Tison
authors.affiliation: Chiara De Cassan, Edoardo Savarino, Giorgia Hatem, Giacomo Carlo Sturniolo, Renata D'Incà, Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Hatem
authors.affiliation: Chiara De Cassan, Edoardo Savarino, Giorgia Hatem, Giacomo Carlo Sturniolo, Renata D'Incà, Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy.
authors.forename: Giacomo Carlo
authors.initials: GC
authors.lastname: Sturniolo
authors.affiliation: Chiara De Cassan, Edoardo Savarino, Giorgia Hatem, Giacomo Carlo Sturniolo, Renata D'Incà, Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy.
authors.forename: Renata
authors.initials: R
authors.lastname: D'Incà
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003093:Colitis, Ulcerative / Q000097:blood / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D005260:Female; D006098:Granulocytes / Q000276:immunology*; D006801:Humans; D007937:Leukapheresis / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000276:immunology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Granulo-monocyto-apheresis; Inflammatory bowel disease; Severity; Therapy; Ulcerative colitis