P520. Efficacy and safety of leucocytapheresis for active inflammatory bowel disease during pregnancy: therapeutic outcomes in four pregnant cases
H. Kinoshita1, R. Kunisaki1, S. Tomohiko1, H. Kimura1, S. Maeda2, 1Yokohama City University Medical Center, Inflammatory Bowel Disease Center, Yokohama, Japan, 2Yokohama City University, Department of Gastroenterology, Yokohama, Japan
Inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis (UC), affects patients who are in their reproductive age. The benefits of maintaining remission before and during pregnancy overweigh the risks of disease flare-ups and associated adverse effects of drug-based medications on the pregnancy outcome. Although most of the medications used to treat IBD appear to be safe during gestation, patients and their partners are still concerned about the influences of medications on fertility and pregnancy. Therapeutic leucocytapheresis is an alternative to conventional drug therapy. Here we report 4 cases of pregnant IBD patients safely treated with either leucocytapheresis (LCAP) or granulocyte/monocyte apheresis (GMA).
Four pregnant IBD patients, three with UC and one with CD, were treated with therapeutic leucocytapheresis. One patient with UC was treated with LCAP and the other three were treated with GMA. One patient had contraindication to corticosteroids and the other three had corticosteroid refractory IBD. Anticoagulation during the procedure was achieved with heparin in three patients, and with nafamostat mesylate in one patient (LCAP).
All four patients responded to therapeutic leucocytapheresis. Two of the three patients with UC achieved steroid free remission before the delivery. Steroid dose was tapered to 5 mg/day in the other patient with UC. In the only CD patient, the symptoms improved, but were not sustained. All three patients with UC delivered healthy babies via uncomplicated vaginal delivery. In the patient with persistently active CD, delivery was carried out by caesarean section at week 36 due to non-reassuring foetal status and the birth weight was 1534g. No adverse effect related to therapeutic leucocytapheresis was observed in these four cases.
In these 4 cases, therapeutic leucocytapheresis was safe and was associated with remission in all three cases with active UC. Additionally, with therapeutic leucocytapheresis, corticosteroid sparing is possible, which is highly desirable in pregnant cases. Regarding CD, we believe a study in larger cohort of pregnant patients is warranted for assessing the efficacy of this non-pharmacologic intervention in this clinical setting.