Brief Article
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Apr 14, 2011; 17(14): 1831-1835
Published online Apr 14, 2011. doi: 10.3748/wjg.v17.i14.1831
Predictive factors of clinical response in steroid-refractory ulcerative colitis treated with granulocyte-monocyte apheresis
Valeria D'Ovidio, Donatella Meo, Angelo Viscido, Giampaolo Bresci, Piero Vernia, Renzo Caprilli
Valeria D'Ovidio, Donatella Meo, Angelo Viscido, Piero Vernia, Renzo Caprilli, Department of Clinical Sciences, Gastrointestinal Unit, Policlinico Umberto I, University of Rome, “La Sapienza”, Viale del Policlinico 155, Rome 00161, Italy
Giampaolo Bresci, Gastrointestinal Unit, Azienda Ospedaliera-Universitaria Pisana, Pisa 56100, Italy
Author contributions: All the authors substantially contributed to conception and design, acquisition of data, or analysis and interpretation of data; all the authors drafted the article, revised it critically for important intellectual content and gave final approval of the version to be published.
Correspondence to: Dr. Valeria D’Ovidio, Department of Clinical Sciences, Gastrointestinal Unit, Policlinico Umberto I, University of Rome, “La Sapienza”, Viale del Policlinico 155, Rome 00161, Italy. vale_do@yahoo.it
Telephone: +39-64-9972384 Fax: +39-64-9972360
Received: January 25, 2010
Revised: March 16, 2010
Accepted: March 23, 2010
Published online: April 14, 2011
Abstract

AIM: To identify factors predicting the clinical response of ulcerative colitis patients to granulocyte-monocyte apheresis (GMA).

METHODS: Sixty-nine ulcerative colitis patients (39 F, 30 M) dependent upon/refractory to steroids were treated with GMA. Steroid dependency, clinical activity index (CAI), C reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), values at baseline, use of immunosuppressant, duration of disease, and age and extent of disease were considered for statistical analysis as predictive factors of clinical response. Univariate and multivariate logistic regression models were used.

RESULTS: In the univariate analysis, CAI (P = 0.039) and ESR (P = 0.017) levels at baseline were singled out as predictive of clinical remission. In the multivariate analysis steroid dependency [Odds ratio (OR) = 0.390, 95% Confidence interval (CI): 0.176-0.865, Wald 5.361, P = 0.0160] and low CAI levels at baseline (4 < CAI < 7) (OR = 0.770, 95% CI: 0.425-1.394, Wald 3.747, P = 0.028) proved to be effective as factors predicting clinical response.

CONCLUSION: GMA may be a valid therapeutic option for steroid-dependent ulcerative colitis patients with mild-moderate disease and its clinical efficacy seems to persist for 12 mo.

Keywords: Granulocyte-monocyte apheresis, Ulcerative colitis, Steroid therapy, Long-term follow-up, Predictive factors