Granulocytapheresis Is Useful as an Alternative Therapy in Patients with Steroid-refractory or -dependent Ulcerative Colitis
| Autor: | Makoto Naganuma, Hiromasa Ishi, Shinsuke Funakoshi, Nagamu Inoue, Hanae Takagi, Toshifumi Hibi, Atsushi Sakuraba, Haruhiko Ogata, Yasushi Iwao |
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| Rok vydání: | 2004 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent medicine.medical_treatment Drug Resistance Gastroenterology Monocytes Adrenal Cortex Hormones Drug tolerance Cyclosporin a Internal medicine medicine Humans Immunology and Allergy Leukapheresis Colitis Adverse effect Colectomy business.industry Remission Induction Drug Tolerance Middle Aged medicine.disease Ulcerative colitis Discontinuation Surgery Clinical trial Treatment Outcome Colitis Ulcerative Female business Granulocytes |
| Zdroj: | Inflammatory Bowel Diseases. 10:251-257 |
| ISSN: | 1078-0998 |
| DOI: | 10.1097/00054725-200405000-00012 |
| Popis: | Background: Recently, granulocyte and monocyte adsorption apheresis (GCAP) has been shown to be safe and effective for active ulcerative colitis (UC). We analyzed the safety and efficacy of GCAP (G-1 Adacolumn) in patients with steroid-refractory and -dependent UC. G-1 Adacolumn is filled with cellulose acetate carriers that selectively adsorb granulocytes and monocytes/macrophages. Methods: Forty-four patients with UC were treated with GCAP. These patients received 5 apheresis sessions over 4 weeks. Twenty patients had steroid-refractory UC (group 1) and 10 had steroid-dependent UC (group 2). Fourteen patients who did not want re-administration of steroids were treated with GCAP at the time of relapse, just after discontinuation of steroid therapy (group 3). Results: Of 44 patients treated with GCAP, 24 (55%) obtained remission (CAI ≤ 4), 9 (20%) showed a clinical response, and 11 (25%) remained unchanged. Only 2 of 10 patients (20%) with severe steroid-refractory UC (CAI ≥ 12) achieved remission, whereas 7 of 10 patients (70%) with moderate steroid-refractory UC achieved remission (p < 0.05). The dose of corticosteroids was tapered in 9 of 10 (90%) patients with steroid-dependent UC after GCAP therapy. Twelve (86%) of 14 patients in group 3 showed an improvement in symptoms and could avoid re-administration of steroids after GCAP. No severe adverse effects occurred. Conclusions: The findings of this study suggest that GCAP may be a useful alternative therapy for patients with moderate steroid-refractory or -dependent UC, although cyclosporin A or colectomy is necessary in patients with severe UC. GCAP may also be useful for avoiding re-administration of steroids at the time of relapse. Randomized, controlled clinical trials are needed to confirm these findings. |
| Databáze: | OpenAIRE |
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