P609 Efficacy of cytapheresis for remission induction therapy and dermatological manifestations of active ulcerative colitis
O. Nomura*, T. Osada, T. Shibuya, D. Ishikawa, K. Haga, N. Sakamoto, T. Ogihara, S. Watanabe
Juntendo University, Gastroenterology, Tokyo, Japan
Erythema nodosum (EN) and pyoderma gangrenosum (PG) are the two major cutaneous ills of extraintestinal manifestations of ulcerative colitis (UC). The biologics and corticosteroids have significantly changed the management of these conditions. However, many patients show loss of response to biologics or their UC becomes refractory to corticosteroids. Cytapheresis can deplete elevated and activated leucocytes in UC patients, and is expected to ameliorate intestinal inflammation. This study was to assess the efficacy of cytapheresis for remission induction and dermatological manifestations of active UC.
A total of 193 cases received cytapheresis for UC between 2008 and 2014. Among these, 172 were for inducing remission including 12 with cutaneous lesions and 21 with quiescent UC for maintenance therapy and corticosteroid tapering. Each patient received weekly or intensive (2-3 sessions/week) cytapheresis up to 10 sessions with either a granulocyte-monocyte apheresis (GMA) column or with a leucocyte removal filter (LCAP). Lichtiger's clinical activity index (CAI) 4 and under meant clinical remission, while 3 and over decrease in CAI meant clinical response. Corticosteroid dose was to be tapered in responders. Remission induction rate, corticosteroid sparing, and the response to skin lesions were factored into our assessment of cytapheresis efficacy.
Relative to baseline, the overall CAI fell from 9.3 ± 3.3 to 4.9 ± 3.5 (P<0.001). The clinical response and remission rates for cytapheresis were 76.2% (GMA 78.2% vs LCAP 70.8%, P=0.31), and 57.6% (GMA 57.3% vs LCAP 58.3%, P=0.90), respectively. Eighty-four patients were receiving systemic steroid, the average daily prednisolone dose at baseline was 19.3 ± 13.1mg, and was reduced to 12.9 ± 10.0mg after cytapheresis (P<0.001). The response and remission rates between the patients with concomitant steroid, biologic or tacrolimus and without concomitant medication were 80.6% and 70.9% (P=0.28), 61.3% and 53.1% (P=0.13), respectively. Patients with skin lesions associated with UC were 12, EN (n=5) and PG (n=7). All 12 cases responded to cytapheresis, notably, 4 EN patients showing rapid remission after the first 2 cytapheresis sessions. Six of 12 cases (1 EN and 5 PG), received concomitant steroid or infliximab. Extracorporeal related non-severe adverse events were observed in 7 of 193 patients.
In this study, cytapheresis was effective as remission induction therapy with significant steroid sparing effect. Additionally, patients with dermatosis associated with UC responded well to cytapheresis. We believe that cytapheresis has a clear efficacy in patients with skin lesions reflecting extraintestinal manifestations of UC.