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P483 Factors affecting the efficacy of granulomonocytapheresis in moderately-to-severely active ulcerative colitis: A multi-centre retrospective study

T. Yamamoto1, T. Iida2, K. Ikeya2, M. Kato2, A. Matsuura2, S. Tamura3, R. Takano3, S. Tani4, S. Osawa4, K. Sugimoto3, T. Shimoyama*1, H. Hanai2

1Yokkaichi Hazu Medical Centre, IBD Centre, Yokkaichi, Japan, 2Hamamatsu South Hospital, Center for Gastroenterology and Inflammatory Bowel Disease Research, Hamamastu, Japan, 3Hamamatsu University School of Medicine, First Department of Medicine, Hamamatsu, Japan, 4Hamamatsu University School of Medicine, Department of Endoscopic and Photodynamic Medicine, Hamamatsu, Japan

Background

Adsorptive granulomonocytapheresis (GMA) with the Adacolumn has been introduced as a non-pharmacologic treatment for ulcerative colitis (UC). A subset of patients who might or might not respond to GMA has not been fully identified. In clinical practice setting, it is important to know which patients are most likely to respond to GMA to avoid futile use of medical resources or widely introduce this safe treatment and to establish its position in the management of UC. This study was conducted at centres with abundant knowledge and experience in GMA therapy with the aim of determining factors affecting the efficacy of GMA in patients with active UC.

Methods

From January 2008 to December 2017, a total of 894 active episodes (first attack or relapse) in 593 patients were treated with GMA (frequency: 1 to 5/week, session time: 60 to 120 min, the maximum number of GMA: 11). Clinical remission was defined as normal stool frequency and no rectal bleeding. Multiple clinical and laboratory parameters at entry were considered for efficacy assessment.

Results

Clinical remission was achieved during 422 (47%) of the 894 treatment cases. In univariate analysis, 6 demographic variables at entry were significantly associated with the likelihood of clinical remission. Patients with a short duration of UC (< 1 year), first UC episode, steroid naïve as well as biologic naïve patients responded well to GMA. In contrast, elderly patients (>60 years) and those with severe endoscopic activity (Mayo endoscopic subscore 3 vs. 2) did not respond well to GMA. The following factors did not affect the likelihood of clinical remission: Gender, duration of the current exacerbation before GMA, severity and the extent of UC, extra-intestinal manifestations, exposure to 5-ASA preparations, immunosuppressant drugs, and adverse events. Laboratory biomarkers at entry (leucocyte, granulocyte, lymphocyte counts, haemoglobin, platelet count, CRP, albumin) were not significantly associated with the clinical remission. In multi-variate analysis, age, duration of UC, Mayo endoscopic subscore, exposure to steroids, and exposure to biologics were independent significant factors. Clinical remission rate was 70% in patients with 4 of the 5 factors, 52% in patients with 3 factors, 46% in patients with 2 factors, 39% in patients with 1 factor, and 18% in patients with none of these factors. Overall, the clinical remission rate was significantly higher in patients with a greater number of the 5 predictors (p < 0.0001).

Conclusion

GMA appeared to be effective in steroid naïve and biologic naïve patients with short duration of UC. Elderly patients (>60 years) and those with severe endoscopic activity did not respond well to GMA.