P288. Therapeutic efficacy of granulocytapheresis in inflammatory bowel diseases: A prospective observational study
R. Sacco1, A. Romano1, M. Bertini1, M. Bertoni1, G. Federici1, A. Mazzoni1, S. Metrangolo1, G. Parisi1, A. Scaramuzzino1, E. Tumino1, F. Scatena1, G. Bresci2
1Pisa University Hospital, Pisa, Italy; 2Pisa University Hospital, Divisione di Gastroenterologia e Malattie del Ricambio, Pisa, Italy
Background: Inflammatory bowel diseases (IBDs) are chronic relapsing conditions. The optimal therapeutic approach to achieve remission is still unclear. We report here our prospective observational experience in the use of granulocytapheresis for the treatment of these conditions and the achievement of long-term remission.
Methods: In total, 70 IBD patients who did not respond to treatment with corticosteroids and mesalamine for four weeks were enrolled in this prospective observational study. Forty patients had total active ulcerative colitis (UC) and 30 presented active Crohn's disease (CD) (16 with ileal location and 14 with ileocolonic location). All patients were treated with granulocytapheresis, using the AdacolumnTM system, an adsorption column which selectively binds granulocytes and monocytes, for one session/week for 5 consecutive weeks. Steroid treatment was not permitted. Disease activity was evaluated by clinical disease index (CAI) in patient with UC and by Crohn's Disease Activity Index (CDAI) in those with CD: a clinical remission was defined as CAI <6 or CDAI <150. All patients were followed for more than 12 months after the end of granulocytapheresis. The endoscopic index (EI) was also evaluated.
Results: All patients completed the study; no complications were reported. After the end of granulocytapheresis, 47/70 (67%) patients showed a clinical remission: 28/40 (70%) of those with UC and 19/30 (63%) of CD subjects. At 6 months after the granulocytapheresis, clinical remission of disease was still observed in 24/40 (60%) UC patients and 16/30 (53%) CD patients; at 12 months, disease remission was reported in 16/40 (40%) UC subjects and 12/30 (43%) CD subjects. The values of CAI, EI, and CDAI before and after the granulocytapheresis are reported in the table.
Conclusions: On the basis of this observational experience, granulocytapheresis appears effective and well tolerated for the treatment of IBD patients. These preliminary findings may suggest the conduction of further randomized multicenter trials, in order to shed new lights on the use of granulocytapheresis for the treatment of IBD.