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P358 Long term efficacy of granulocyte-monocyte-apheresis in ulcerative colitis elderly patients. The Italian Registry of Therapeutic Apheresis.

R. Sacco*1, V. D'Ovidio2, A. Romano3, M. Bertini4, M. Bertoni4, G. Federici1, S. Metrangolo3, E. Tumino1, P. Giuseppe1, G. Bresci1, V. Mismas1, P. Vernia2

1Pisa University Hospital, Gastroenterology, Pisa, Italy, 2Policlinico Umberto I, Gastroenterology, Rome, Italy, 3Pisa University Hospital, Gastroenterology, Pisa, Italy, 4Pisa University Hospital, Gastroenterology , Pisa, Italy

Background

Granulocyte-monocyte-apheresis (GMA) is effective in the treatment of ulcerative colitis (UC). Thanks to its favorable safety profile, the use of this technique could be particularly suitable for elderly patients. However, information on the efficacy of GMA in this population is still scant. This observational study investigates the efficacy of GMA in elderly patients included in the Italian Registry of Therapeutic Apheresis.

Methods

Data of elderly (>65 years) patients with mild/moderate UC treated with a standard protocol of GMA (5 sessions in 5 weeks) were evaluated. Clinical evaluations were performed at 3, 12 and 24 months since the end of GMA session. The following parameters were assessed: incidence of clinical remission (CAI [Colits Active Index] <4); erythrocyte sedimentation rate (ESR); c-reactive protein (CRP); white cells blood count (WBC). Endoscopical evaluations were performed at a 3-month follow-up: the incidence of endoscopical remission (EAI [endoscopical activity index] 0/1) was assessed.

Results

Data for 74 patients (51 males, median age 68 years; CAI 7.12) were available; 62 patients were either steroid-resistant or steroid-dependent. The proportion of patients with remission of disease was 64% at 3 months, 62% at 12 months and 60% at 24 months. At 24 months, all other efficacy parameters had improved from baseline: CAI (7.12 vs 3.2), ESR (34.82 vs 12.8 mm/h), CRP (4.45 vs 0.80 mg/dl) and WBC (8.11 vs 6.12) (p<0.001 for all comparisons).

Endoscopic data were available for 32 patients. The incidence of mucosal healing was 44%; all patients with mucosal healing presented a clinical remission over the entire follow-up period.

No major adverse events were reported during GMA sessions.

Conclusion

Data collected on a sample of elderly patients included in the Italian Registry of therapeutic apheresis show that GMA is a safe and effective procedure over a long-term follow-up also in this population. Mucosal healing appears strongly associated with clinical remission.