title: Factors associated with treatment outcome, and long-term prognosis of patients with ulcerative colitis undergoing selective depletion of myeloid lineage leucocytes: a prospective multicenter study.
abstract: BACKGROUND
  Patients with ulcerative colitis (UC) have elevated/activated myeloid lineage leucocytes and may respond favorably to adsorptive granulocyte/monocyte apheresis (GMA). However, there are patients who respond well to GMA, and patients who do not benefit. Therefore, predictive factors of GMA efficacy need to be defined.
  
  
  METHODS
  In a prospective multicenter setting, 200 UC patients at 32 institutes received one GMA session per week over 10 weeks. Patients who achieved remission were followed for 12 months. The Clinical Activity Index (CAI) ≤3 meant remission, and response meant CAI decreased by ≥3. Quality of life was evaluated by the Inflammatory Bowel Disease Questionnaire (IBDQ).
  
  
  RESULTS
  After final GMA, remission, response and no response rates were 67.0%, 15.0% and 18%, respectively. The remission group had a significant decrease in myeloid leucocytes and platelets. Corticosteroid dose decreased (P < 0.001); 49 of 97 patients on corticosteroids became steroid-free. Baseline CAI was lower in the remission group versus non-remission (P < 0.01), whereas IBDQ was higher in the remission group versus non-remission (P < 0.05). After 12 months, 52 of 134 patients had maintained remission. Disease duration was longer in the relapsed group versus maintained remission group (P = 0.041). Male gender, first UC episode and corticosteroid responder were significant factors for maintaining remission, whereas corticosteroid dependent UC was associating with relapse.
  
  
  CONCLUSIONS
  Selective myeloid leucocyte depletion was effective for remission induction and improving patients' quality of life. Baseline demographics such as disease activity level, duration and corticosteroid dependency appear to predict response to GMA. Additionally, patients with a first UC episode who were drug naive responded well to GMA and achieved a favorable long-term disease course by avoiding pharmacologics from an early stage of their inflammatory bowel disease. These findings should help to end unnecessary use of medical resources by targeting GMA to patients who may respond well.
authors: Division of Internal Medicine, Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Hyogo, Japan. Electronic address: yoko0502@hyo-med.ac.jp.
authors: Yoko
authors: Y
authors: Yokoyama
authors: Department of Gastroenterology, Osaka City General Hospital, Osaka, Japan.
authors: Kenji
authors: K
authors: Watanabe
authors: Kinshukai Infusion Clinic, Osaka, Japan.
authors: Hiroaki
authors: H
authors: Ito
authors: Nishishita Intestinal Hospital, Osaka, Japan.
authors: Masakazu
authors: M
authors: Nishishita
authors: Dojima Digestive Tract Internal Medicine Clinic, Osaka, Japan.
authors: Koji
authors: K
authors: Sawada
authors: Department of Gastroenterology, Japan Red Cross Kyoto Daiichi Hospital, Kyoto, Japan.
authors: Yusuke
authors: Y
authors: Okuyama
authors: Department of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan.
authors: Kazuichi
authors: K
authors: Okazaki
authors: Department of Endoscopy and Ultrasound, Nara Medical University, Nara, Japan.
authors: Hisao
authors: H
authors: Fujii
authors: Division of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Hiroshi
authors: H
authors: Nakase
authors: Gastroenterology, and Proctology, Ikoma Clinic, Osaka, Japan.
authors: Tsutomu
authors: T
authors: Masuda
authors: Division of Internal Medicine, Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Hyogo, Japan; Chyokyu Hospital, Himeji, Hyogo, Japan.
authors: Ken
authors: K
authors: Fukunaga
authors: Division of Gastroenterology, Shiga University School of Medicine, Shiga, Japan.
authors: Akira
authors: A
authors: Andoh
authors: Division of Internal Medicine, Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Hyogo, Japan.
authors: Shiro
authors: S
authors: Nakamura
mesh_terms: D000327:Adsorption; D000328:Adult; D001781:Blood Component Removal; D019070:Cell Lineage; D003093:Colitis, Ulcerative / Q000097:blood / Q000628:therapy*; D005260:Female; D006098:Granulocytes / Q000166:cytology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007958:Leukocyte Count; D007962:Leukocytes / Q000166:cytology*; D008297:Male; D009000:Monocytes / Q000166:cytology; D022423:Myeloid Cells / Q000166:cytology*; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: long-term prognosis; myeloid lineage leucocytes; platelets; predictive factor of response to therapy; ulcerative colitis