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P238. Granulocytapheresis on the treatment of ulcerative colitis: Results from four centres in Castile and Leon

A. Fernandez1, F. Muñoz2, L. Fernandez3, J. Barrio4, A. Rodríguez1

1Hospital of Salamanca, Salamanca, Spain; 2Complejo Asistencial de Leon, Leon, Spain; 3Hospital Clinico Universitario de Valladoilid, Valladolid, Spain; 4Hospital Universitario Rio Hortega de Valladolid, Valladolid, Spain

Objectives: We want to assess the effectiveness of leukocyte apheresis on clinical practice according to the results obtained in four health centres of Castile and Leon.

Material and Methods: This study includes all the patients with ulcerative colitis who underwent apheresis. They were monitored in the Inflammatory Bowel Disease Unit of all the centres that took part on the study. The following parameters were included in the analysis: Age; sex; time of evolution of the disease between the diagnosis and the beginning of the treatment; extension of the disease, seriousness of the outbreak, number of lesions and therapeutic approach; maintenance and adverse reactions. We considered a clinical response at the end of the treatment as a partial response, and the following criteria were required for the category of “complete remission” six months after the end of the treatment: no presence of corticoids, no need of new immunosuppressant and/or biological drugs or surgery.

Results: A total of 48 patients were included in the study (58.3% men, average age 32±14.5 years). The mean time between diagnosis and the beginning of the treatment was 44±80 months. Most of the patients (88.9%) presented a moderate outbreak when the apheresis started, and 52.1% showed extensive colitis. The most common indication for the apheresis (50%) was the failure of other treatments (CGs, IMS, biological agents), followed by corticoid dependency (37.5%). 70.8% of the patients received immunomodulators when the apheresis started. 68.8% of the patients showed a good response at the end of the treatment, and 31.3% reached remission. 33% of the patients remained under maintenance treatment, and 56.3.% of them reached remission. 10 patients (20.8%) required total colectomy during the follow-up period. There was a low proportion of adverse effects (14.6%), most of them related with an alteration of the venous drainage. No statistically significant differences were found with regard to the previous use of immunosuppressant or biological drugs, or with the seriousness, extension, therapeutic approach, age, sex or time of evolution of the disease.

Conclusions: Leukocyte apheresis has proven to be an effective and safe technique in the treatment of ulcerative colitis in situations of corticoid dependency or whenever there is no response to other treatments, with remission rates of 31.1% without corticosteroids 6 months after the end of the treatment. It has been shown to be a safe approach with no serious adverse effects that may lead to an interruption of the treatment.