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P306. Apheresis efficacy in ulcerative colitis

G.J. Gómez, L. Ballesteros, P. Martínez, B. Casis, J.A. Chirinos, A. Masedo, F. Sánchez, C. Yela, G. Castellano

Hospital 12 de Octubre, Madrid, Spain

Objective: To determine the efficacy of the Leukocyte Granulocyte Apheresis (LGA) (Adacolumn®) in patients with Ulcerative Colitis (UC) being followed in our Inflammatory Bowel Disease Unit.

Methods: A retrospective analysis was done of all our adult patients with UC who had undergone LGA with at least 12 months follow up after their last session. We recorded patient demographics (age, gender), UC extent and activity according to Montreal classification, side effects to LGA, previous treatments and treatments within one year after the last LGA including steroids, immunomodulators and biologics, response to LGA as defined by clinical remission with steroid withdrawal, and need for repeat LGA or surgery within 12 months following the last LGA.

Results: Thirty cases of UC who had undergone LGA were identified. Five cases were excluded, 2 due to incomplete follow up (less than 12 months) and 3 cases who were unable to complete LGA therapy due to inability to gain intravenous access in 2 cases and one case developing a presyncopal episode during treatment. Of the remaining 25 who completed treatment, 44% (n = 11) were female and 56% (n = 14) male. The median age was 35 years (IQR 29–45). Sixteen patients were classified as pancolitis (E3) and 9 with left sided colitis (E2). All patients were receiving steroids and 5-ASA when LGA was commenced. Fourteen (56%) were on immunomodulators and five (20%) on biological agents. The most frequent indication was steroid dependency in 15 cases (60%), followed by 6 cases (24%) of steroid resistance with chronic mild to moderate disease (S1-S2) and 4 cases (16%) in whom steroids were contraindicated with moderate to severe disease (S2-S3). The median number of sessions was 10 (IQR 5–10), with clinical response obtained in 20 cases (80%). Of these 20 cases, 40% (n = 8) did not require any further treatment to maintain remission, 10% (n = 2) required biologics alone, 10% (n = 2) required repeat LGA treatment and 40% (n = 8) required steroids within 12 months of follow up. Of the 8 requiring steroids, 4 were also treated with biological agents and 2 required repeat treatment with LGA. Surgery was not required in any of our patients during the study period. Therapy was well tolerated, with 4 cases reporting headache and one case with a presyncopal episode requiring cessation of therapy

Conclusions:

  • LGA is a well tolerated technique with few side effects
  • In our patient population, there was a high percentage of initial clinical response
  • Within 12 months of LGA, there was a high remission rate without the need for further maintenance or rescue therapies
  • Further randomized control trials are require to optimize the most effective LGA regimen for induction of remission and the possibility of subsequent maintenance.