P337. Maintenance treatment of chronic refractory IBD-patients with granulocyte/monocyte adsorption
P337. Maintenance treatment of chronic refractory IBD-patients with granulocyte/monocyte adsorption
A. Lindberg1, M. Eberhardson1, P. Karlen2
1Karolinska Institutet, Dept. of Clinical Science and Education, Gastroenterology and Hepatology Södersjukhuset Stockholm Division of Gastroenterology Danderyd Hospital, Stockholm, Sweden; 2Karolinska Institutet, Dept. of Clinical Science Division of Gastroenterology Danderyd Hospital, Stockholm, Sweden
Background: IBD-patients with chronic active inflammation often demonstrate higher risk of serious complications. Combinations of immunosuppression and biological treatment are often used in this patient group. We have recently published our experiences with Granulocyte/Monocyte Adsorption (GMA) over long-term follow-up including re-treatment at relapse [1]. All patients who initially responded to GMA also responded to subsequent GMA re-treatments indicating that maintenance therapy may be an interesting option for these chronic refractory IBD-patients.
Methods: Thirty-six chronic refractory IBD-patients (defined as at least six months duration without remission in spite of conventional treatment in optimal time and dosage) initially achieving clinical and endoscopic remission after GMA received maintenance treatment with GMA. Seven patients were excluded from evaluation due to pregnancy (n = 3), ongoing systemic corticosteroid treatment (n = 2), vasculitis (n = 1) and colonostomy as fistula treatment (n = 1). The rationale for the remaining twenty-nine patients (17 CD/12 UC) subjected to maintenance treatment was: relapse within 12 months (n = 15), TNF-alfa failures (n = 8), postoperative colon cancer (n = 1), severe diabetes mellitus (n = 1), osteopenia (n = 1), children (n = 2) and multiresistent bacteria (n = 1). The GMA maintenance treatments was scheduled with one session monthly (n = 13), every second month (n = 8) every third month (n = 7) and every fourth month (n = 1) according to relapse rate and disease severity. Clinical evaluation was performed in connection with the GMA treatments
Results: Twenty-nine patients received a total of 244 GMA sessions and the population attained 358 months in systemic steroid-free clinical remission (1.47 months of remission per apheresis session). Two patients relapsed and received intense GMA-treatment achieving re-remission. Nine of the 17 Crohn patients had been exposed to anti-TNF. Eight were unexposed to TNF-alfa due to colon cancer, multiresistent bacteria, pregnancy, frequent infections and four patients were reluctant to anti TNF treatment. Eighteen patients had previously used tiopurins and 11 were still on immunosuppressants. No serious side-effects were seen.
Conclusions: IBD-patients with chronic disease activity despite conventional medication who respond to an initial GMA course seem to benefit from GMA maintenance treatment.
1. Lindberg A, Eberhardson M, Karlsson M, Karlen P (2010), Long-term follow-up with Granulocyte and Monocyte Apheresis re-treatment in patients with chronically active inflammatory bowel disease. BMC Gastroenterol. 10: p. 73.