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P520 Endoscopic evaluation and factors affecting the endoscopic efficacy during 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 is a novel non-pharmacologic strategy for treating patients with ulcerative colitis (UC). Multiple studies in Japan and Europe found that GMA was safe and therapeutically effective in patients with active UC. However, endoscopic efficacy and factors affecting the endoscopic efficacy during GMA have not been fully evaluated. This study was conducted at three IBD centres with the aim of assessing endoscopic efficacy of GMA and determining factors affecting the endoscopic efficacy during GMA.

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). At entry, endoscopic evaluation was made in all patients. After treatment, mainly, the most affected segment at entry was observed. Endoscopic remission (= mucosal healing: MH) was defined as a Mayo endoscopic subscore of 0 or 1 after treatment.

Results

After treatment, 28 patients could not have endoscopy because 24 required emergency colectomy during GMA therapy and 4 had serious deterioration of UC at the end of the GMA therapy. These 28 patients were analysed as non-responders in the endoscopic assessment. Overall, MH was observed in 351 of the 894 treatment cases (39%). When sub-grouped, MH was achieved in 378 of 678 treatment cases (47%) with Mayo endoscopic subscore 2 at entry, which was significantly higher than 32 of 216 (15%) with Mayo endoscopic subscore 3 (p < 0.0001). In univariate analysis, 6 demographic variables at entry were significantly associated with the likelihood of endoscopic remission (MH). Patients with a short duration of UC (<1 year), first UC episode and proctosigmoiditis, and steroid naïve patients responded well to GMA endoscopically. In contrast, patients with severe clinical activity (Mayo score 10–12 vs. 6–9) and those with severe endoscopic activity (Mayo endoscopic subscore 3 vs. 2) did not respond well to GMA endoscopically. The following factors did not affect the likelihood of endoscopic remission (MH): Age, gender, duration of the current exacerbation before GMA, extra-intestinal manifestations, exposure to 5-ASA preparations, immunosuppressant and biologic agents, and adverse events. In multi-variate analysis, clinical severity, endoscopic severity, extent of UC, exposure to steroids and exposure to biologics were independent significant factors.

Conclusion

Approximately 40% of patients with moderately-to-severely active UC achieved MH during GMA. Clinical severity, endoscopic severity, extent of UC, exposure to steroids and exposure to biologics are independent significant factors for the endoscopic efficacy of GMA.