Granulocyteaphaeresis in steroid‐dependent inflammatory bowel disease: a prospective, open, pilot study

Abstract

Summary Background : Uncontrolled studies suggest that granulocyteaphaeresis might be useful in the management of active ulcerative colitis. Aim : To assess the efficacy of granulocyteaphaeresis treatment in active steroid‐dependent inflammatory bowel disease. Methods : We conducted a multicentre, prospective, open, pilot study in patients with steroid‐dependent inflammatory bowel disease. All patients were started on 60 mg/day of prednisone; after 1 week, a five‐session programme of granulocyteaphaeresis (once per week) was started. The steroid dose was tapered weekly if there was clinical improvement. Remission was defined as an inactive clinical activity index together with complete withdrawal of steroids at week 6. The patients were followed up for at least 6 months or until disease relapse. Results : Twenty‐six patients (14 ulcerative colitis, 12 Crohn's disease) were included. More than a half had been previously treated with immunomodulators. Remission was achieved in 62 and 70% of ulcerative colitis and Crohn's disease, respectively. During a median follow‐up of 12.6 months, six of eight ulcerative colitis patients maintained their clinical remission; however, only one Crohn's disease patient remained in remission after the first 6 months of follow‐up. Conclusions : Granulocyteaphaeresis is a safe treatment option in inflammatory bowel disease. A five‐session programme of granulocyteaphaeresis seems to be efficient in the treatment of steroid‐dependent ulcerative colitis, but not in Crohn's disease.

Evaluation of 5 versus 10 granulocyteaphaeresis sessions in steroid-dependent ulcerative colitis: A pilot, prospective, multicenter, randomized study

“…Furthermore, all responding patients but one completed a one year long-term follow up without requiring steroids or the introduction of any other therapy. These results are in keeping with the findings reported by Domenech et al [8] and support the steroid sparing effect of GCAP in steroid dependent UC patients. Interestingly, steroid consumption in our study was lower in group 2, showing statistically significant difference in a period starting when group 1 patients were no longer receiving aphaeresis treatment, and group 2 was still under active aphaeresis treatment.…”

“…Reducing granulocytes and monocytes by apheresis has the potential to reduce bowel inflammation and to improve patient status. Several controlled and uncontrolled studies have assessed the safety and efficacy of granulocyteaphaeresis (GCAP) in steroid-dependent UC [5][6][7][8] , steroid-refractory UC [9][10][11] , or as first-line therapy in naïve UC patients [12,13] . However, the optimal treatment scheme is still to be established.…”

Endoscopic findings can predict the efficacy of leukocytapheresis for steroid-naive patients with moderately active ulcerative colitis

“…However, steroid administration can increase susceptibility to infections, diabetes mellitus and osteoporosis. Recently, it was reported that steroidrefractory or steroid-dependent patients with UC can be effectively treated by cytapheresis [7][8][9][10] . To determine whether leukocytapheresis (LCAP) may also be useful with other UC patients, we administered LCAP to 18 steroid-naive UC patients.…”

Granulocitoaféresis en la enfermedad inflamatoria intestinal: Eficacia a 32 semanas con protocolo de inducción y sesiones de mantenimiento

“…En nuestro país, Doménech y cols. realizaron un estudio multicéntrico prospectivo incluyendo a 14 pacientes con CU corticodependiente a los que al inicio de las sesiones de GCAF (5 sesiones en 5 semanas) se administraba una dosis inicial de 60 mg de prednisona con reducción semanal de 10 mg de la dosis de corticoides, comprobando una remisión clínica en el 60% de los pacientes a 6 semanas con reducción en la dosis de esteroides en el 90% y mantenimiento de la remisión en el 75% de los respondedores tras 12,6 meses de seguimiento (11). En CU corticorrefractaria merece la pena comentar el estudio más amplio en cuanto a pacientes, llevado a cabo por Hanai y cols.…”