P453. Long-term clinical impact of early introduction of granulocyte and monocyte adsorptive apheresis in new onset ulcerative colitis
T. Yamamoto1, M. Shiraki1, S. Umegae1, K. Matsumoto1, 1Yokkaichi Social Insurance Hospital, Inflammatory Bowel Disease Centre, Yokkaichi, Japan
The efficacy of granulocyte and monocyte adsorptive apheresis (GMA) for patients with a first episode of ulcerative colitis (UC) has been scarcely reported. This study was to see if the introduction of GMA at an early stage reduces corticosteroid administration and steroid dependency in the long term clinical course of UC.
Forty consecutive patients with moderately active symptoms as the first attack of UC were included. Twenty patients were treated with GMA, with or without corticosteroids (GMA group), and the other 20 were given corticosteroids without GMA (steroid group). GMA with the Adacolumn (90 minutes/session, at 30 mL/minute) was administered weekly. Patients who did not achieve clinical remission (normal stool frequency and no rectal bleeding) after 5 GMA sessions were given 5 additional sessions. All patients were monitored for 5 years. Relapses were treated in the same manner as the first attack in both groups. The total dose of steroid administered and the appearance of steroid-dependency were to be compared between the two groups.
Patients were well matched between the groups with respect to age, sex, duration of symptoms before entry, disease activity index score, medications before entry, and extraintestinal manifestations. All patients in both groups achieved clinical remission after the first attack. The mean number of relapses per patient was 2.8 in the GMA group and 2.9 in the steroid group (P = 0.86). During this study, 5 patients in the GMA group did not require corticosteroids. The mean dose of steroid administered during the 5 years was 2,141 mg in the GMA group vs 5,443 mg in the steroid group (P = 0.002). One patient in the GMA group and 7 in the steroid group were steroid-dependent at the end of the study (P = 0.048).
In patients with the first UC episode, GMA therapy at an early stage significantly reduces steroid administration and steroid-dependency in the long-term clinical course.