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P309. Interest of apheresis (Adacolumn®) in the treatment of ulcerative colitis

P309. Interest of apheresis (Adacolumn®) in the treatment of ulcerative colitis

N. Mathieu, A. Kervegant, N. Lazaar, P. Bichard, B. Bonaz

Department of Gastroenterology and Liver Diseases, Grenoble Cedex 09, France

Ulcerative colitis (UC) is characterized by an influx into the mucosa of neutrophils and monocytes/macrophages. Removal of activated circulating leucocytes is a therapeutically attractive principle. Adacolumn® (Otsuka Pharmaceuticals) is an adsorptive type extracorporeal leukocyte apheresis device where the apheresis column is filled with specially designed cellulose acetate beads as the adsorptive carriers. Adacolumn® is efficient in the treatment of steroid-refractory or -dependent UC.

Aim: To evaluate the efficacy of Adacolumn® in moderate-to-severe active steroid-dependent, steroid-refractory, or refractory UC to any treatment.

Methods: Consecutive patients with moderate to severe active UC, proximal to the rectum, with a clinical activity index (CAI) ≥ 6, were included from November 2007 to June 2010. Patients were receiving one or more of the following therapies: (i) sulfasalazine or mesalazine for ≥ 4 weeks, with a stable dose for the last 2 weeks; (ii) prednisone with a stable dose for the last 2 weeks; (iii) azathioprine for ≥ 12 weeks, with a stable dose for the last 4 weeks; (iv) anti-TNF (infliximab or adalimumab) for at least 8 weeks. For completion of the apheresis, an adequate peripheral venous access was required to allow treatment. All patients underwent apheresis treatment using the Adacolumn® apheresis device. Venous blood from one antecubital vein was passed through the column at a flow rate of 30 mL/min for 60 min (1.8 L blood was exposed to the carriers) and returned to the contralateral antecubital vein. Five apheresis were performed (once a week over 5 consecutive weeks). A clinical, biological and endoscopical follow-up was performed in all patients.

Results: Fourteen patients (9 men, 5 women; mean age: 47 years, range: 32–71) with a left-sided colitis (n = 12) or pancolitis (n = 2) with a mean CAI of 9.2 (range: 6–15), a mean CRP of 28 (range: 10–50), and a mean endoscopic activity index (EAI) of 8.6 (range: 5–12) were included. Patients were cortico-dependent (n = 7), cortico-resistant (n = 3), and had previous 5-ASA (n = 14), azathioprine (n = 11), methotrexate (n = 3), infliximab (n = 7), adalimumab after failure of infliximab (n = 5), and tacrolimus (n = 1). The mean follow-up was 15 months (range: 1–37). After 5 apheresis, mean CAI was 6 in 11 patients (range: 0–14) and mean EAI was 6 (range: 0–12). Mean CRP was 80 in 5 patients (range: 5–130) and normalized in the other patients. A colectomy was performed in 4 patients (29%) with a mean follow-up of 4.5 months (range: 1–7). A weaning of steroids was obtained in 8 patients. After a median follow-up of 15 months, 9 patients are in remission: 1 without any treatment, 2 under 5-ASA, 1 under azathioprine, 1 under tacrolimus, 4 under biotherapies (3 infliximab, 1 adalimumab). The only adverse event observed was headache in 4 patients (28.6%).

Conclusion: In our hands, apheresis (Adacolumn®) appears as a safe technique and is of interest in cortico-dependent patients with a non severe endoscopic activity.