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P522. Cytapheresis as remission induction therapy in 154 ulcerative colitis patients: A five year experience

O. Nomura, T. Shibuya, T. Osada, D. Ishikaw, N. Sakamoto, T. Ogihara, S. Watanabe, Juntendo University, Gastroenterology, Tokyo, Japan

Background

Hitherto, patients with active ulcerative colitis (UC) who do not respond to the first-line salicylates have been treated with corticosteroids and more recently with anti-tumour necrosis factor (TNF) biologics or cyclosporine A, while thiopurines have been given to maintain remission. At present, all drug based medications potentially initiate adverse side effects, which can further complicate the patients' ongoing disease. Additional, with time, many patients lose response to biologics or their UC becomes refractory to corticosteroids. However, patients with active UC are known to harbour elevated myeloid lineage leucocytes like the CD14(+)CD16(+) monocytes, a major source of TNF. Therefore, selective depletion of these leucocytes should be considered for UC patients.

Methods

A total of 154 patients were admitted to our hospital to underdo cytapheresis for UC patients between 2008 and 2013. Thirteen patients with UC in remission for steroid tapering were excluded in this evaluation. If clinical course was improved, the dose of steroid administration was tapered. Each patient received weekly or intensive (2 sessions/week) cytapheresis up to 10 sessions with either a granulocyte/monocyte adsorption (GMA) or with a leucocyte adsorption (LCAP) column. Lichtiger's clinical activity index (CAI) 4 or less was defined as clinical remission, while 3 or more points decrease in CAI meant clinical response. Additionally, patients who responded to cytapheresis, but subsequently relapsed could undergo cytapheresis retreatment. The safety and efficacy of the two cytapheresis systems was observed.

Results

The clinical response and remission rates for cytapheresis 73.8% (GMA 76.4 vs LCAP 65.7%, p = 0.21) and 51.1% (GMA 51.9 vs LCAP 48.6%, P = 0.73) respectively. Baseline average of CAI 9.7±3.3 decreased to 4.9±3.4 (P < 0.01). Sixty-five patients were using systemic steroid therapy. The average daily prednisolone dose at baseline was18.7±13.3 mg, significantly reduced to 13.0±10.4 mg after treatment (P < 0.01). In subgroup analyses, 17 patients achieved remission without any concomitant medication. The remission rate in patients with a concomitant medication (steroid, biologic or tacrolimus) was 58.5% vs 45.3% for patients without concomitant medication (p = 0.14). In total 56 patients underwent cytapheresis retreatment, the remission rate was 64.3%. Extracorporeal related non-severe adverse events were observed in 9 patients.

Conclusion

Cytapheresis was safe and effective as remission induction therapy with significant steroid sparing potential. Additionally, patients who subsequently relapse should respond well to cytapheresis. We believe that patients who respond to cytapheresis and avoid pharmacologics potentially have a better future UC clinical course.