Granulocytapheresis is useful as an alternative therapy in patients with steroid-refractory or -dependent ulcerative colitis

Makoto Naganuma, Shinsuke Funakoshi, Atsushi Sakuraba, Hanae Takagi, Nagamu Inoue, Haruhiko Ogata, Yasushi Iwao, Hiromasa Ishi, Toshifumi Hibi

Research output: Contribution to journalArticle

112 Citations (Scopus)

Abstract

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 readministration 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.

Original languageEnglish
Pages (from-to)251-257
Number of pages7
JournalInflammatory Bowel Diseases
Volume10
Issue number3
DOIs
Publication statusPublished - 2004 May

Fingerprint

Complementary Therapies
Ulcerative Colitis
Steroids
Blood Component Removal
carboxyamido-triazole
Granulocytes
Monocytes
Recurrence
Colectomy
Group Psychotherapy
Cyclosporine
Adsorption
Adrenal Cortex Hormones
Randomized Controlled Trials
Macrophages
Safety

Keywords

  • Granulocytpheresis
  • Steriod-refractory
  • Steroid-dependency
  • Ulcerative colitis

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Granulocytapheresis is useful as an alternative therapy in patients with steroid-refractory or -dependent ulcerative colitis. / Naganuma, Makoto; Funakoshi, Shinsuke; Sakuraba, Atsushi; Takagi, Hanae; Inoue, Nagamu; Ogata, Haruhiko; Iwao, Yasushi; Ishi, Hiromasa; Hibi, Toshifumi.

In: Inflammatory Bowel Diseases, Vol. 10, No. 3, 05.2004, p. 251-257.

Research output: Contribution to journalArticle

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abstract = "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 readministration 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.",
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AU - Naganuma, Makoto

AU - Funakoshi, Shinsuke

AU - Sakuraba, Atsushi

AU - Takagi, Hanae

AU - Inoue, Nagamu

AU - Ogata, Haruhiko

AU - Iwao, Yasushi

AU - Ishi, Hiromasa

AU - Hibi, Toshifumi

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