Abstracts of the World Apheresis Association 10th Congress Hosted by the American Society for Apheresis at its 25th Annual Meeting 5–8 May 2004 at the Loews Miami Beach Hotel, Miami Beach, Florida, USA
- Publisher
- John Wiley and Sons
- Year
- 2004
- Tongue
- English
- Weight
- 391 KB
- Volume
- 19
- Category
- Article
- ISSN
- 0733-2459
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✦ Synopsis
Purpose: Drug therapy of ulcerative colitis (UC) is associated with unpleasant side effects and its efficacy decrease with chronic use. Leukocyte-derived inflammatory cytokines are suspected to be major factors in the initiation and perpetuation of UC. Accordingly, leukocytes should be appropriate targets for therapy. To reduce leukocytes in peripheral blood, membrane filters like the Cellsorba column and leukocyte adsorbing beads like Adacolumn have been developed for removing leukocytes. These were then used to treat patients with UC. Methods: Two independent prospective multicenter randomized controlled studies were conducted in patients with active UC. Patients were assigned to two treatment groups: I, high dose prednisolone treated (h-PSL.I) group for whom PSL dose was increased from around 25 to 60 mg/day, or granulocytapheresis (GCAP) treated group for whom one session/week for 5 weeks of GCAP was added without increasing steroid; II, another high doses PSL treated (h-PSL.II) group or leukocytapheresis (LCAP) treated group for whom one session/week for 5 weeks of LCAP was added without increasing steroid. These therapies were adjuncts to on going drug therapies. Results: Efficacy was 58.5% (31 of 53 patients) in the GCAP and 46.2% (24 of 52 patients) in h-PSL.I. Similarly, efficacy of LCAP was 74.4% (29 of 39 patients) and 37.8% (14 of 37 patients) in the h-PSL.II. Incidences of adverse side effects were 10.2% (6 of 59 patients) in GMA.I and 41.1% (23 of 56 patients) in the h-PSL as well as 25.6% (10 of 39 patients) in the LCAP and 70.3% (26 of 37 patients) in the h-PSL.II. The data show that the efficacy in both leukocyte apheresis groups were higher together with fewer incidences of side effects compared with high dose steroid therapy. They could decrease several pro-inflammatory cytokines productions by peripheral blood leukocytes. Further, the mean doses of PSL were significantly lower in both leukocyte apheresis groups compared to the high dose steroid groups.
Conclusions:
Hence, these studies have demonstrated that leukocyte apheresis as an adjunct to an on going drug therapy for the treatment of active UC was more effective and safer compared to intensive therapy with high dose PSL. The results should further understanding of the pathophysiology of UC.