Observational Study
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World J Gastroenterol. Dec 7, 2014; 20(45): 17155-17162
Published online Dec 7, 2014. doi: 10.3748/wjg.v20.i45.17155
Granulo-monocyto apheresis is more effective in mild ulcerative colitis than in moderate to severe disease
Chiara De Cassan, Edoardo Savarino, Piero Marson, Tiziana Tison, Giorgia Hatem, Giacomo Carlo Sturniolo, Renata D’Incà
Chiara De Cassan, Edoardo Savarino, Giorgia Hatem, Giacomo Carlo Sturniolo, Renata D’Incà, Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy
Piero Marson, Tiziana Tison, Apheresis Unit, Blood Transfusion Service, University of Padua, 35128 Padua, Italy
Author contributions: De Cassan C, Savarino E, Marson P, Tison T, Hatem G, Sturniolo GC and D’Incà R design of the study, analysis and interpretation of the data, drafting of the article, critical revision of the article for important intellectual content, final approval of the article.
Correspondence to: Chiara De Cassan, MD, Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, via Giustiniani 2, 35128 Padua, Italy. chiaradecassan@gmail.com
Telephone: +39-49-8217749 Fax: +39-49-8760820
Received: January 27, 2014
Revised: May 17, 2014
Accepted: June 26, 2014
Published online: December 7, 2014
Abstract

AIM: To evaluate whether the effectiveness of Granulo-monocyto apheresis (GMA), a technique that consists of the extracorporeal removal of granulocytes and monocytes from the peripheral blood, might vary according to the severity of ulcerative colitis (UC) in patients with mild to moderate-severe disease UC activity.

METHODS: We retrospectively reviewed prospectively collected data of patients undergoing GMA at our inflammatory bowel disease centre who had at least a 6 mo of follow-up. The demographics, clinical and laboratory data were extracted from the patients’ charts and electronic records. The severity of UC was scored according to the Modified Truelove Witts Severity Index (MTWSI). A clinical response was defined as a decrease from baseline of ≥ 2 points or a value of MTWSI ≤ 2 points.

RESULTS: A total of 41 (24 males/17 females; mean age 47 years) patients were included in the study. After GMA cycle completion, 21/28 (75%) of mild UC patients showed a clinical response compared with 7/13 (54%) of patients with moderate to severe disease (P = 0.27). At 6-mo, 14/28 (50%) of the mild UC patients maintained a clinical response compared with 2/13 (15%) of the patients with moderate to severe disease (P = 0.04). After the GMA cycle completion and during the 6-mo follow up period, 13/16 (81%) and 9/16 (56%) of mild UC patients with intolerance, resistance and contraindications to immunosuppressants and/or biologics showed a clinical response compared with 2/6 (33%) and 0/6 (0%) of patients with moderate to severe disease activity with these characteristics (P = 0.05 and P = 0.04, respectively).

CONCLUSION: Patients with mild UC benefit from GMA more than patients with moderate to severe disease in the short-term period. GMA should be considered a valid therapeutic option in cases of contraindications to immunosuppressants, corticosteroids and/or biologics.

Keywords: Ulcerative colitis, Granulo-monocyto-apheresis, Inflammatory bowel disease, Therapy, Severity

Core tip: Several studies evaluating granulo-monocyto apheresis in ulcerative colitis have been previously conducted, and these studies have shown conflicting results. We performed a retrospective study evaluating granulo-monocyto apheresis effectiveness according to disease severity. Granulo-monocyto-mpheresis was found to be more effective in patients with mild disease activity than in patients with moderate to severe disease activity.