Sustained effect of leukocytapheresis/granulocytapheresis versus anti-human TNF-α monoclonal antibody on ulcerative colitis - a 2-year retrospective study -

Abstract

Background: Although anti-TNF-α monoclonal antibody (BP) agents are widely used as an established treatment tool for refractory ulcerative colitis (UC), whether leukocytapheresis/granulocytapheresis (L/G-CAP) has similar beneficial impact on the disease activity remains undetermined. Furthermore, the costs defrayed for the treatment with these two modalities have not been compared. Methods: We retrospectively evaluated whether L/G-CAP offered sustained beneficial effects over 2-year period. The patients who had moderately to severely active UC (Rachmilewitz Clinical Activity Index (CAI)≧5) and were treated with a series (10 sessions) of L/G-CAP (n=19) or BP (n=7) as an add-on therapy to conventional medications were followed. Furthermore, the cost-effectiveness pertaining to the treatment with L/G-CAP and BP was assessed over 12 months. Results: At baseline, L/G-CAP and BP groups manifested similar disease activity (CAI, L/G-CAP; 7.0 [6.0-10.0], BP; 10.0 [6.0-10.0], p=0.207). The L/G-CAP and BP treatment suppressed the activity, with CAI 1 or less attained on day 180. When the L/G-CAP group was dichotomized into L/G-CAP-high and L/G-CAP-low group based on CAI values (≥3 or <3) on day 365, CAI was gradually elevated in L/G-CAP-high group but remained suppressed in L/G-CAP-low group without additional apheresis for two years. Anemia was corrected more rapidly and hemoglobin levels were higher in BP group. The cost of the treatment with L/G-CAP over 12 months was curtailed to 76% of that with BP (1.79 [1.73-1.92] vs. 2.35 [2.29-3.19] million yen, p=0.028). Conclusions: L/G-CAP is as effective as BP in a substantial number of patients over two years. The cost for the treatment of UC favors L/G-CAP although the correction of anemia may prefer BP. Thus, L/G-CAP can effectively manage the disease activity with no additional implementation for two years although further therapeutic modalities might be required in a certain population with high CAI observed on day 365. Trial registration: This study is a retrospective analysis evaluating the long-term efficacy of L/G-CAP and anti-TNF-α monoclonal antibody agents on the disease activity during a total of two years, and also assessing the costs of the treatment for UC over 12-month period (UMIN trial No. 000036954). The study was approved by the Ethics Committee of Tokyo Bay Urayasu Ichikawa Medical Center (Chiba, institutional approval No. 376) and Keiyu Hospital (Yokohama, Kanagawa, institutional approval No. R3-26) with waiver of the requirement for obtaining informed consent, and was conducted in accordance with the Declaration of Helsinki. Information from medical records was anonymized and de-identified prior to final analysis.