Adsorptive Granulocyte and Monocyte Apheresis Is Effective in Ulcerative Colitis Patients Both with and without Concomitant Prednisolone

Keiji Matsuda; Kohei Ohno; Yuka Okada; Takahiro Yagi; Mitsuo Tsukamoto; Yoshihisa Fukushima; Atsushi Horiuchi; Ryu Shimada; Tsuyoshi Ozawa; Tamuro Hayama; Takeshi Tsuchiya; Junko Tamura; Hisae Iinuma; Keijiro Nozawa; Hitoshi Aoyagi; Akari Isono; Koichiro Abe; Shinya Kodashima; Takatsugu Yamamoto; Yoshitaka Kawasaki; Yoshifuru Tamura; Yuko Sasajima; Fukuo Kondo; Yojiro Hashiguchi

doi:10.1159/000505484

Adsorptive Granulocyte and Monocyte Apheresis Is Effective in Ulcerative Colitis Patients Both with and without Concomitant Prednisolone

Inflamm Intest Dis. 2020 Feb;5(1):36-41. doi: 10.1159/000505484. Epub 2020 Jan 28.

Authors

Keiji Matsuda^{1

2}, Kohei Ohno¹, Yuka Okada¹, Takahiro Yagi¹, Mitsuo Tsukamoto¹, Yoshihisa Fukushima¹, Atsushi Horiuchi¹, Ryu Shimada^{1

2}, Tsuyoshi Ozawa^{1

2}, Tamuro Hayama^{1

2}, Takeshi Tsuchiya^{1

2}, Junko Tamura¹, Hisae Iinuma¹, Keijiro Nozawa^{1

2}, Hitoshi Aoyagi^{2

3}, Akari Isono^{2

3}, Koichiro Abe^{2

3}, Shinya Kodashima^{2

3}, Takatsugu Yamamoto^{2

3}, Yoshitaka Kawasaki⁴, Yoshifuru Tamura⁴, Yuko Sasajima⁵, Fukuo Kondo⁵, Yojiro Hashiguchi^{1

2}

Affiliations

¹ Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
² IBD Center, Teikyo University School of Medicine, Tokyo, Japan.
³ Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan.
⁴ Department of Renal Center, Teikyo University School of Medicine, Tokyo, Japan.
⁵ Department of Pathology, Teikyo University School of Medicine, Tokyo, Japan.

Abstract

Background: The number of ulcerative colitis (UC) patients is increasing in Japan and other countries. Selective depletion of myeloid lineage leucocytes by adsorptive granulocyte and monocyte apheresis (GMA) with an Adacolumn (JIMRO, Takasaki, Japan) was introduced as a nonpharmacologic treatment strategy in UC patients in 2000. GMA has been reported to be effective in clinical trials; however, the effect of concomitant prednisolone (PSL) on GMA needs to be clarified.

Methods: Thirty-nine patients with active UC were treated with GMA at our institute between June 2009 and September 2018. All patients received GMA therapy once or twice a week with the Adacolumn. Conventional medication was to be continued during the whole GMA treatment course. The clinical response was retrospectively evaluated.

Results: According to the partial Mayo score, remission was 33.3%, significant efficacy 25.6%, effective 25.6%, and no response 15.4%. The average partial Mayo score was 6.2 ± 1.4 at entry and significantly declined to 1.8 ± 1.8 after GMA sessions (p < 0.0001). The average number of bowel movements was 9.5 ± 5.6 at entry and significantly declined to 3.0 ± 2.8 after GMA sessions (p < 0.0001). In a comparison between the group treated with concomitant PSL and the group without PSL, the change in partial Mayo score or the number of bowel movements from entry to after GMA sessions was not significantly different. Among 24 patients treated by GMA with concomitant PSL, 75% (18/24) became steroid free.

Conclusions: The effect of GMA with concomitant PSL and that of GMA without PSL were not different, and GMA was effective irrespective of PSL administration. The present study showed that GMA had efficacy and led many UC patients treated by PSL to be steroid free with no safety concern in the real world, although there is the possibility of recruitment bias due to the retrospective nature of the study.

Keywords: Adsorptive granulocyte and monocyte apheresis; Colonoscopy; Inflammatory bowel disease; Mayo score; Steroid free; Ulcerative colitis.