title: Granulocyte/Monocyte Adsorptive Apheresis in Moderate to Severe Ulcerative Colitis--Effective or Not?
abstract: OBJECTIVE
  Adsorptive granulocyte/monocyte apheresis (GMA) has shown promising efficacy in the treatment of patients with ulcerative colitis (UC). But a sham-controlled study was negative. A post-hoc analysis of this trial may haul out patients responding to GMA.
  
  
  METHODS
  A total of 168 UC patients with a disease activity (DAI) between 6 and 11 were enrolled in this study. Out of 168 patients, 112 received GMA and 56 sham apheresis. The basis for this post hoc analysis is the clinical study report issued by Otsuka America Pharmaceutical.
  
  
  RESULTS
  Baseline histology was available for 165 patients. Only 38% (63 of 165) of patients showed microscopic erosion/ulceration (group P). The remaining 62% of patients did not show microscopic erosion/ulceration (group A). The patients in group P showed significantly higher DAI, flexible proctosigmoidoscopy score and neutrophil infiltration into the colonic mucosa than those in group A (p = 0.0132, p = 0.0243 and p < 0.0001, respectively). Likewise, group P patients had a significantly (p = 0.0275) higher remission rate (11 of 46; 23.9%) when treated with GMA than with sham procedure (0 of 17; 0%).
  
  
  CONCLUSIONS
  Patients in group P who had more active UC than those in group A showed clear clinical efficacy in response to GMA. We believe that true DAI should be specified for further randomized controlled trials.
authors.affiliation: Clinic for Gastroenterology, Pulmonology and General Internal Medicine, Evangelisches Krankenhaus Kalk, University of Cologne, Cologne, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Kruis
authors.forename: Phuong
authors.initials: P
authors.lastname: Nguyen
authors.forename: Julia
authors.initials: J
authors.lastname: Morgenstern
mesh_terms: D000328:Adult; D000368:Aged; D003093:Colitis, Ulcerative / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D006098:Granulocytes; D006801:Humans; D007413:Intestinal Mucosa / Q000276:immunology; D007937:Leukapheresis / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009000:Monocytes; D020556:Neutrophil Infiltration; D011446:Prospective Studies; D012074:Remission Induction / Q000379:methods; D012720:Severity of Illness Index; D012812:Sigmoidoscopy; D016896:Treatment Outcome