P529. Effect of the combination therapy of intensive granulocyte and monocyte adsorption apheresis and thiopurines in patients with early-diagnosed Crohn's disease
T. Fukuchi1, H. Nakase2, M. Matsuura2, T. Yoshino2, T. Toyonaga2, S. Ubukata1, A. Ueda1, H. Yamashita1, K. Ashida1, 1Osakafu Saiseikai Nakatsu Hospital, Gastroenterology and Hepatology, Osaka, Japan, 2Kyoto university Hospital, Gastroenterology and Hepatology, Kyoto, Japan
Maintenance of remission is important for patients with Crohn's disease (CD). The advent of biological drugs has had a significant impact on the management of CD. However, safety of long-term treatment with biologics is still uncertainty. D'Haens G et al. reported the effect of administration of short-term TNF-alpha antagonist combined with thiopurines on newly-diagnosed CD. Their data demonstrated efficacy of early use of thiopurines in CD as maintenance therapy without long-term use of TNF- alpha antagonist. Thus, optimal induction therapies combined with use of thiopurines are favorable for CD to avoid complications. Therapeutic effect and safety of granulocytes and monocytes adsorptive apheresis (GMAA) on IBD is focused because this system can be expected to be natural biological therapy in that selectively removing granulocytes and monocytes/macrophages to produce of TNF-alpha. However, it remains unclear that combined therapy with GMAA and thiopurines would be useful for early-diagnosed CD. Aims of this study are to investigate the effect of GMAA as induction therapy combined with thiopurines on patients with early-diagnosed CD.
Nineteen patients with early-diagnosed CD (13 male, 2 female; mean age 39±3 years) were treated with GMAA and thiopurines. Early-diagnosed CD was defined as follows; within the 2 years after diagnosis, had not previously received corticosteroids and biologics, did not have past history of operation and endoscopic dilation for CD. Each patient received intensive GMAA (twice per week for 5weeks). Clinical response was assessed after the end of GMAA. Efficacy endpoint included clinical improvement (decrease in Crohn's disease activity index [CDAI] >70), and remission (CDAI ≤150). Simple endoscopic score for CD (SES-CD) was evaluated after GMAA.
Ten patients had only colonic lesions, three patients had small intestinal lesions alone and two patients had both small and large intestinal lesions. Mean CDAI score was 265±13. Fourteen (93%) of 15 patients were considered responders. Of 14 responders, 12 patients (80%) achieved to remission. One patient did not improve. Mean CDAI for all patients decreased significantly from 265±13 to 123±17 (P < 0.001). Mean of SES-CD decreased significantly from 9±4 to 4±4. No serious adverse effect was observed. Fourteen patients with thiopurines achieved remission within 54weeks after GMAA.
Combination therapy of intensive GMAA and thiopurines could be novel option for early-diagnosed CD.