Granulocyte-monocyte adsorptive apheresis in pediatric inflammatory bowel disease: Results, practical issues, safety, and future perspectives
✍ Scribed by T. Ruuska; V. Wewer; F. Lindgren; P. Malmborg; M. Lindquist; L. Marthinsen; L. Browaldh; T. Casswall; M. Kalliomäki; J. Grönlund
- Publisher
- John Wiley and Sons
- Year
- 2009
- Tongue
- English
- Weight
- 126 KB
- Volume
- 15
- Category
- Article
- ISSN
- 1078-0998
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✦ Synopsis
Background:
The purpose of the study was to collect data on granulocyte-monocyte adsorptive apheresis (gma) for the treatment of corticosteroid-dependent (sd) or corticosteroid-resistant (sr) inflammatory bowel disease (ibd) in children from 3 nordic countries to evaluate its efficacy and safety and to assess practical issues.
Methods:
Retrospective data on 37 children treated with gma were collected. in all, 22 children had ulcerative colitis (uc), 13 crohn's disease (cd), and 2 had indeterminate colitis (ic). their mean age was 13.2 years, range 5-17 years, and mean duration of disease was 2.4 years, range 1 month to 6 years. indication for treatment in the uc group was sd in 11 cases, sr in 6 cases, and other reasons in 5 cases. the corresponding numbers in the cd group were sd in 8 cases, sr in 2 cases, and other reasons in 3 cases. in the ic group, 1 had sd and 1 was refractory to steroids, azathioprine, and infliximab. efficacy was evaluated by severity indices: the pediatric ulcerative colitis activity index (pucai) and the pediatric crohn's disease activity index (pcdai) and tapering of corticosteroids.
Results:
Pucai and pcdai decreased significantly in both groups after 3 months (p = 0.0007, p = 0.025). the dosage of corticosteroid was significantly reduced in the uc group by the end of gma (p = 0.004) and this response continued after 3 months. relapse was seen in 2 patients with uc and 3 patients with cd after 3 months follow-up.
Conclusions:
Gma seems to be an effective and safe treatment in 81% of the sd or sr pediatric ibd patients, especially in those with uc.