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P345. Short- and long-term efficacy of granulocytapheresis in patients with active steroid-dependent ulcerative colitis refractory or intolerant to thiopurines. A retrospective single-centre study

F.J. Fernandez-Perez, A. Moreno, F.J. Fernandez-Cano, F. Rodriguez Gonzalez, M.A. Romero Ordoñez, M. Gonzalez Barcenas, Hospital Costa del Sol, Gastroenterology, Marbella, Spain

Background

Valoration of clinical response at 12 and 52 weeks in patients with active steroid-dependent ulcerative colitis (UC) refractory or intolerant to thiopurines using granulocytapheresis (GCAP) in induction or induction plus maintenance schedules. Need for Colectomy, anti-TNF use and ability to withdraw steroids were also valorated at 12 and 52 weeks after initiation of GCAF.

Methods

Retrospective, single-centre series of 27 UC patients treated with GCAP from 2004 to 2011. GCAP (Adacolumn®) was performed by peripheral vein access with induction (5 sessions in 5 weeks, group A) or induction plus maintenance schedule (5 sessions in 5 weeks plus a monthly session, group B). Statistical analysis was carried out by Fisher's exact test using SPSS-20.

Results

We reviewed 27 patients, mean age 38 years-old (15–81). UC extension included: E1–4 patients, E2–8 patients and E3–15 patients. At the begining of GCAP, 19/27 patients were on oral sistemic corticosteroids while 8/27 in oral topically-acting corticosteroids.. In 14 patients (52%) GCAP consisted in induction plus maintenance sessions. At 12 weeks response was achieved in 48% of patients, for 30% at 52 weeks. When comparing response rate at 12 and 52 weeks in groups A and B, 11% and 7.4% of patients in group A and 29.6% and 22.2% were in clinical response or remission at 12 and 52 weeks respectively. At 52 weeks Anti-TNF was used in17/27 patients (62.9%) and 6/27 required colectomy (22.2%), while 8/27 (29.6%) patients could avoid anti-TNF or colectomy and were on clinical response or remission. Of these, 6 out of 8 were free of steroids.

Conclusion

At 52 weeks almost one third of steroid-dependent and thiopurine-refractory or intolerant UC patients treated with GCAP achieved remission/response.and avoided anti-TNF treatment or colectomy. Response rates were more consistent in patients treated with induction and maintenance GCAP.