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P195. Role of white cell apheresis in refractory ulcerative colitis: UK experience

C. Ford, P. Premchand, D. Venkama

Queen's Hospital Romford, BHR NHS Trust, Romford, United Kingdom

Background: White cell apheresis (WCA) has been an effective treatment for patients with steroid-refractory and steroid-dependent IBD. Here we report further success from the largest UK cohort of patients to date with severe colitis treated with Adacolumn (Otsuka Pharmaceutical, Tokyo, Japan).

Aims and Methods: We retrospectively reviewed the case notes of 18 patients with steroid-refractory (n = 8/18)/steroid-dependent (n = 10/18) ulcerative colitis referred to our service and receiving white cell apheresis from January 2008 until October 2010. Our aim was to establish rates of remission and relapse post treatment.

Inclusion criteria prior to treatment were (i) evidence of severe inflammation macroscopically at endoscopy with (ii) histological confirmation of severe disease and (iii) intractable symptoms despite conventional treatment. Response post treatment was defined as improvement in symptoms, achievement of remission and cessation of long-term steroids.

Results: Of 18 patients; 14 patients responded (n = 14 77.8%) to treatment with Adacolumn. Remission was seen in 13 of 18 patient (n = 13 72.2%), 2 of these patients had minor relapses (n = 2 11.1%) which settled with a short course of steroids of less than one months duration. Mean remission period was calculated as 300 days.

Of non responders 2 patients underwent colectomy (n = 2 11.1%). 1 adverse event was reported (deep vein thrombosis 27 days after completion of treatment). Mean duration of follow up was 328 days.

Discussion: WCA has generated much enthusiasm in the specialist field of IBD. It offers a potential alternative to patients with severe steroid-dependent/-refractory colitis who have failed conventional treatments and may otherwise face colectomy.

This study is limited by small sample size and relatively short follow up period which may lead to under-reporting of adverse events and over-estimation of remission rates. However, even considering these limitations this data suggests favourable outcomes which if replicated in larger randomised controlled trials could establish WCA as a firm option in the armamentarium available to the clinician facing the therapeutic challenge of steroid-refractory/-dependent colitis.

In an era dominated by monoclonal antibody therapies, this data supports WCA as a promising alternative for patients with severe colitis in whom biologics are not tolerated/contraindicated in addition to patients who have failed these treatments.

Conclusion: WCA has shown effectiveness in this cohort of 18 patients with severe refractory colitis. Randomised controlled studies are now essential if WCA is to replicate this success on a large scale. Considering its established safety profile this may in the future define a role for WCA as a first line therapeutic option in the treatment of severe steroid-refractory/-dependent colitis.

Graph 1. Response and remission rates amongst 18 patients with steroid-refractory/-dependent ulcerative colitis receiving Adacolumn White cell apheresis.