P330. Treatment of children and adolescents with ulcerative colitis by adsorptive depletion of elevated myeloid lineage leucocytes as mono-therapy or in combination with low dose prednisolone
T. Tanaka1, S. Sugiyama1, H. Goishi1, H. Yamada1, 1Akitsu Prefectural Hospital, Hiroshima, Japan
In children, and adolescent with ulcerative colitis (UC), medications like 5-aminosalicylic acid (5ASA), thiopurines, prednisolone (PSL), or biologicals can adversely affect the patients' growth and development. Further, UC patients have elevated myeloid lineage leucocytes including CD14+CD16+ monocytes, which release tumour necrosis factor-alpha. Hence selective depletion of these cells by granulocyte/monocyte adsorption (GMA) with an Adacolumn should alleviate inflammation and promote remission. However, GMA seems to work well in PSL naïve and first episode cases (Suzuki, et al. Gastroenterology 2005), but disappointing outcome was reported in patients refractory to multiple drugs or with extensive loss of the mucosal tissue (Sands, et al. Gastroenterology 2008). We thought that young UC patients should respond to GMA.
We assessed the efficacy of GMA in growing patients as mono-therapy or in combination with low dose PSL if mono-therapy was ineffective. Seventeen children and adolescents, age 11–19 years, each was to receive 5 GMA sessions, 2 sessions in the first week, and then weekly sessions. Patients who achieved a decrease of at least 5 point in the clinical activity index (CAI) were to receive additional weekly GMA, up to 6 sessions, while poor responders were to receive 20 mg/day PSL plus additional GMA session. 5ASA was the only concomitant medication, which had started longer than 8 weeks prior to GMA. At entry and week 12, patients were clinically and endoscopically evaluated, allowing each patient to serve as her or his own control.
Five patients did not respond well to the initial 5 GMA sessions and were given PSL plus GMA, while 12 patients responded to the first 5 GMA sessions and received further sessions. At entry, the average CAI was 14.1±0.4, range 11–17, and the average endoscopic index was 9.2±0.3, range 7–11. The corresponding values at week 12 were 2.1±0.2, range 1–4 (P < 0.001) and 2.4±0.2, range 1–4 (P < 0.001), respectively. Therefore, 12 patients achieved remission with GMA as mono-therapy and 5 patients achieved remission with GMA plus PSL. PSL was tapered to 0 mg within 3 months.
In this study, GMA in children and adolescents with UC, who were corticosteroid naïve was associated with clinical remission and mucosal healing. Therefore, there are patients who may respond well to GMA and be spared from pharmacologicals. Additionally, GMA is favoured by patients for its good safety profile and being a non-drug intervention.