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P407. Predictive factors for the efficacy of leukocytapheresis in ulcerative colitis

K. Mitsuyama1, K. Nagayama1, H. Takedatsu1, T. Kobayashi1, H. Yamasaki1, K. Kuwaki1, S. Yoshioka1, O. Tsuruta1, M. Sata1, 1Kurume University School of Medicine, Division of Gastroenterology, Department of Medicine, Kurume, Japan

Background

Leukocytapheresis (LCAP) has been reported to be a safe and effective treatment for active ulcerative colitis (UC). However, the factor predicting the efficacy of LCAP had not been yet established. The aim of this study was to perform the univariate analysis of the predictive factor for the efficacy of LCAP in patients with UC.

Methods

Between October 2001 and March 2011, LCAP therapy was conducted in Kurume University Hospital for 41 patients with moderate to severe UC which involves the left-sided to entire colon. These patients received the LCAP treatment from total 5 to 10 sessions once weekly. Disease activity was evaluated clinically by the Lichtiger's clinical activity index (CAI) and endoscopically by the Rachmilewitz index. Univariate analysis in retrospective based on the patient's case record was performed to identify the predictive factors which affected the therapeutic effect [1], the rapid response (responds within 3-sessions of LCAP) [2], and the long term remission [3].

Results

[1] The LCAP treatment showed 75.0% of clinical remission (Lichtiger's CAI of 4 or less than) and 11.1% of clinical response (the reduction of ≥5 points or half from baseline). A significant difference (p = 0.0369) was observed in body mass index with univariate analysis performed between clinical responders and non-responders. [2] 47.2% of the LCAP-treated patients had rapid effects (the clinical remission and response after 3 LCAP sessions). The sex differed significantly between rapid responders and non-rapid responders (p = 0.0411). [3] Patients with male (p = 0.0222), first attack (p = 0.0005), elevated CRP levels (pre-treatment level, p = 0.0041), high leukocyte counts (post-treatment level, p = 0.0181), low endoscopic scores (post-treatment level, p = 0.0282) and low erythrocyte sedimentation rate (post-treatment level, p = 0.0029) achieved a long-term remission.

Conclusion

This study demonstrates the clinical efficacy of LCAP in active UC patients and also indicates that the induction of remission by repeated sessions of LCAP therapy is important to maintain the long-term remission.