Positions of selective leukocytapheresis in the medical therapy of ulcerative colitis

Figure 1 Study design and patient selection for selective leukocytapheresis with the Adacolumn (GMA) in patients with steroid refractory and steroid naïve ulcerative colitis. iv prednisolone (PSL) indicates intravenous PSL (60 mg/d); oral PSL (40-60 mg/d). The dose of 5-ASA was 1.5-2.25 g/d while the dose of SZ was 2-3 g/d. During GMA course, PSL was tapered or discontinued in patients who improved. As shown, 56 steroid refractory and 28 steroid naïve patients were randomly selected for GMA, and the rest were treated according to Figure 5.

Figure 2 Fall of clinical activity index (CAI) during the course of Adacolumn GMA in patients with steroid refractory, steroid naïve and steroid dependent ulcerative colitis.

Figure 3 Typical endoscopic response in steroid refractory patients. Modified from Hanai et al, Dig Dis Sci 2002; 47: 2349-2353 with kind permission of Springer Science and Business Media.

Figure 5 Treatment algorithm for ulcerative colitis without corticosteroids. Based on this scheme, patients at any stage of their disease might benefit from GMA and avoid corticosteroids or other drug based medications. Intensive leukocytapheresis (2 or more GMA sessions per week in the first 3 wk) is recommended in severe or fulminating cases. GMA: Granulocyte and monocyte adsorption apheresis; 5-ASA: 5-aminosalicylic acid; 6-MP: 6-Mercaptopurine; AZA: Azathioprine.

Figure 4 Release of interle-ukin-1 receptor antagonist (IL-1ra) and IL-10 in the Adacolumn during Adacolumn GMA in patients with active ulcerative colitis. Column outflow returns to the patients. Elevated IL-1ra and IL-10 (both anti-inflammatory) in the column outflow is potentially very significant (see text for comments on IL-1ra and IL-10).