P445. Looking for predictive factors of clinical response to adsorptive granulocyte and monocyte apheresis in patients with ulcerative colitis
M. Kawai1, Y. Yokoyama1, K. Fukunaga1, T. Ogawa1, K. Kamikozuru1, K. Nagase1, K. Tozawa1, N. Hida1, T. Matsumoto1, 1Hyogo College of Medicine, Department of Lower Gastroenterology, Nishinomiya, Japan
Adsorptive granulocyte and monocyte apheresis (GMA) with an Adacolumn in patients with ulcerative colitis (UC) has been applied as a non-pharmacological treatment strategy, but the efficacy has been encouraging as well as discouraging, depending on patients' demography at entry. In this study, we looked for predictive factors for clinical response to GMA.
In a retrospective setting, 43 outpatients who had been treated with GMA for active UC were evaluated. Patients were divided into remission group (RG) and non-remission group (NRG) based on Lichtiger's clinical activity index (CAI) before and after 10, once a week GMA sessions. Patients with CAI >5 were classified as having active disease, while CAI ≤4 meant clinical remission. The efficacy was analysed in relation to patients' demographic variables.
After 10 GMA sessions, clinical remission rate was 53.5% (23/43). Among the 23 responders, 9 patients (39.1%) had steroid-free remission. At baseline, the duration of UC was significantly shorter in the remission group as compared with the non-remission group, 6.1±7.3 vs. 8.6±6.8 (P < 0.05). Likewise the mean interval between relapse and the first GMA session was significantly shorter in the remission group compared with the non-remission group, 27.3±31.0 days vs. 57.7±54.4 days, respectively (P < 0.05). Multiple logistic regression analysis showed that the interval between relapse and the first GMA session (p = 0.008, 95% CI 0.939–0.991), and concomitant azathioprine (AZA, P = 0.043, 95% CI 0.009–0.923) and lower haemoglobin at first GMA session (P = 0.043, 95% CI 0.298–0.980) were significant predictive factors for clinical response to GMA.
In this study, patients with a short duration of UC seemed to respond well to GMA. However, we found that the best responders were patients who received GMA immediately after a relapse. Additionally, GMA was effective in patients with active UC while on AZA. The data from this study should spare medical cost and reduce morbidity time for many patients, relevant for decision making in clinical settings.