P491 In patients with active ulcerative colitis, cytapheresis spares corticosteroids, and reduces hospitalisation time: therapeutic outcomes in 181 consecutive patients.
O. Nomura*, T. Osada, T. Shibuya, D. Ishikawa, K. Haga, N. Sakamoto, S. Watanabe
Juntendo University, Department of Gastroenterology, Tokyo, Japan
Cytapheresis has been introduced as one therapeutic option in patients with active ulcerative colitis (UC). The therapeutic efficacy of cytapheresis is attributed to the depletion of activated leucocytes as significant sources of inflammatory cytokines in UC patients. With this background in mind, we investigated the efficacy of cytapheresis on UC activity, extraintestinal complications, corticosteroid sparing (either avoiding corticosteroids or discontinuing) and hospitalisation avoidance in patients with active UC.
In clinical practice settings, between 2008 and 2015, a total of 181 consecutive patients with active UC underwent cytapheresis as remission induction therapy. In 13 patients, UC was complicated by dermatosis. Cytapheresis was done with either the adacolumn or the cellsorba filter column, at one or 2 sessions per week, up to 10 sessions (1 course). Clinical activity index (CAI) ≤ 4 meant clinical remission, and when CAI decreased by at least 5 points but remained above 5, this meant response to cytapheresis. Hospitalisation avoidance was defined as patients with severe UC (CAI ≥ 11) who received cytapheresis therapy in an outpatient setting corticosteroid sparing was defined as patients with a CAI of ≥ 5 within 1 month after one cytapheresis course, but could avoid corticosteroid.
In all 181 cases who received cytapheresis as remission induction therapy, the CAI score (mean ± SD) decreased from 9.4 ± 3.4 to 4.9 ± 3.5 (p < 0.001). The clinical remission and response rates were 53.6% (97 of 181 patients) and 71.3% (129 of 181 patients), respectively. Hospitalisation avoidance was 93.5% or 29 of 31 in patients with severe UC who were treated by cytapheresis as outpatients. Further, 14 (45.1%) of the 31 with severe UC responded to cytapheresis monotherapy. The remission and the response rates were 45.2% and 77.4%, respectively in this sub-group. Corticosteroid sparing was achieved in 85 of 98 patients (86.7%) who were with moderate-to-severe UC, but could avoid corticosteroid. Further, corticosteroid discontinuation within one month after the cytapheresis course was achieved in 18 of 83 patients (21.7%). The total corticosteroid dose (mean ± SD) decreased from 18.15 ± 14.13 to 12.43 ± 11.40 (p <0.001). In the 13 patients with extraintestinal complications, marked decreases in skin lesions were observed. Notably, 4 patients with refractory erythema nodosum (EN), received cytapheresis without concomitant medication, the skin lesions remitted in 2 of the 4 patients with EN.
Cytapheresis therapy was associated with significant efficacy together with a marked steroid sparing effect. Additionally most patients who otherwise would have been treated as inpatients avoided hospitalisation.