Hanai, H.; Takeuchi, K.; Iida, T.; Tozawa, K.; Tanaka, T.; Saniabadi, A.; Watanabe, F.; Maruyama, Y.; Matsushita, I.; Yamada, M.; Kikuchi, K.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA62
Academic Journal
Frequent relapse during steroid tapering is common in many patients with ulcerative colitis (UC) who initially respond to intensive medication including a corticosteroid. Such cases are said to have steroid-dependent (SD) UC. Further, increased granulocyte and monocyte counts, activation and prolonged survival time is a feature of mucosal inflammation in active UC. Likewise, faecal calprotectin (a neutroph protein) level parallels intestinal inflammation and predicts UC relapse We thought that granulocyte and monocyte apheresis (GMA) to reduce the circulating level of these leucocytes might suppress relapse during the steroid tapering in SD patients. Forty six patients with SD UC, mean age 38±14 yr, CAI (clinical activity index) 9.2, DAI (disease activity index) 8.6 were given 10 GMA sessions, one session/week for 10 consecutive weeks, by using a 335 mL capacity column filled with 220g cellulose acetate beads of 2 mm in diameter as the column adsorptive carriers (Adaco]umn). The carriers selectively adsorb granulocytes and monocytes. Duration of one GMA sessions was 60 minutes, flow rate 30mL/minute. At week 12, CAI was 1.7 DAI 2.8 (n=46) and 39 of 46 patients were in remission. The mean dose of prednisolone, 18 mg/patient/day at entry was reduced to 11 mg at week 12 and to 4mg at week 20. Further, at week 20, 42 patients were in remission, 2 had improved, and 2 had relapsed. The treatment was well tolerated and no serious side effects were observed. In conclusion, GMA appeared to be an effective adjunct to standard drug therapy of active UC by promoting remission and suppressing relapse during steroid tapering. It seems that reduction of circulating level of activated granulocytes alleviates inflammation and contributes to remission. However, the full efficacy of GMA is unlikely to be due to reduction of granulocytes per se. Results from other studies together with basic research indicate a marked decline in inflammatory cytokine generation and reduced...


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