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Long-term follow-up with Granulocyte and Monocyte Apheresis re-treatment in patients with chronically active inflammatory bowel disease.

Lindberg A, Eberhardson M, Karlsson M, Karlén P - BMC Gastroenterol (2010)

Bottom Line: Fourteen patients who relapsed after showing initial remission were re-treated with GMA and 13 (93%) went into a second remission.Following further relapses, all of seven patients were successfully re-treated for the third time, all of three patients for the fourth time and one for a fifth time.Re-treatment of relapsing remission patients seems to be effective.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset SE-118 83 Stockholm, Sweden.

ABSTRACT

Background: Patients with IBD and chronic inflammation refractory to conventional therapy often demonstrate higher risk of serious complications. Combinations of immunosuppression and biological treatment as well as surgical intervention are often used in this patient group. Hence, there is need for additional treatment options. In this observational study, focused on re-treatment and long-term results, Granulocyte/Monocyte Adsorption (GMA, Adacolumn) treatment has been investigated to study efficacy, safety and quality of life in IBD-patients with chronic activity.

Methods: Fifteen patients with ulcerative colitis and 25 patients with Crohn's disease, both groups with chronically active inflammation refractory to conventional medication were included in this observational study. The patients received 5-10 GMA sessions, and the clinical activity was assessed at baseline, after each completed course, and at week 10 and 20 by disease activity index, endoscopy and quality of life evaluation. Relapsed patients were re-treated by GMA in this follow-up study up to 58 months.

Results: Clinical response was seen in 85% and complete remission in 65% of the patients. Ten patients in the UC-group (66%) and 16 patients in the CD-group (64%) maintained clinical and endoscopic remission for an average of 14 months. Fourteen patients who relapsed after showing initial remission were re-treated with GMA and 13 (93%) went into a second remission. Following further relapses, all of seven patients were successfully re-treated for the third time, all of three patients for the fourth time and one for a fifth time.

Conclusions: IBD-patients with chronic inflammation despite conventional therapy seem to benefit from GMA. Re-treatment of relapsing remission patients seems to be effective.

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Related in: MedlinePlus

Scores on Harvey Bradshaw Index (HB) and Ulcerative Colitis Disease Activity Index (UCDAI) in boxplots. Boxes show interquartile range at each time. Median in bold. Differences in median score between time points were tested by the Mann-Whitney test, p-values presented. P-value ≤ 0,05 was considered significant HB score >5 is defined as active disease. UCDAI score of 3 to 6 is defined as mild, 7 to 10 as moderate and 11 to 12 as severe disease
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Figure 2: Scores on Harvey Bradshaw Index (HB) and Ulcerative Colitis Disease Activity Index (UCDAI) in boxplots. Boxes show interquartile range at each time. Median in bold. Differences in median score between time points were tested by the Mann-Whitney test, p-values presented. P-value ≤ 0,05 was considered significant HB score >5 is defined as active disease. UCDAI score of 3 to 6 is defined as mild, 7 to 10 as moderate and 11 to 12 as severe disease

Mentions: A total of 453 GMA procedures were performed and adequate venous access was achieved in all patients. Thus, no patients were excluded due to inadequate venous access. Out of 40 patients with chronically inflamed mucosa (15 with UC and 25 with CD) and refractory to conventional medications, 34 (85%) responded to GMA. Furthermore, 26 patients, ten with UC and 16 with CD (65%) achieved clinical as well as endoscopic remission for an average of 14 months, ranging from two to 58 months (Figure 1). The laboratory data are summarised in Table 2. HBI- and UC-DAI-outcome, significant when assessed between baseline and 20 weeks follow-up, are displayed as box plots in Figure 2. Data from three patients are missing (UC-DAI and HBI were initiated from the second patient and one CD-patient had ileostoma).


Long-term follow-up with Granulocyte and Monocyte Apheresis re-treatment in patients with chronically active inflammatory bowel disease.

Lindberg A, Eberhardson M, Karlsson M, Karlén P - BMC Gastroenterol (2010)

Scores on Harvey Bradshaw Index (HB) and Ulcerative Colitis Disease Activity Index (UCDAI) in boxplots. Boxes show interquartile range at each time. Median in bold. Differences in median score between time points were tested by the Mann-Whitney test, p-values presented. P-value ≤ 0,05 was considered significant HB score >5 is defined as active disease. UCDAI score of 3 to 6 is defined as mild, 7 to 10 as moderate and 11 to 12 as severe disease
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2914086&req=5

Figure 2: Scores on Harvey Bradshaw Index (HB) and Ulcerative Colitis Disease Activity Index (UCDAI) in boxplots. Boxes show interquartile range at each time. Median in bold. Differences in median score between time points were tested by the Mann-Whitney test, p-values presented. P-value ≤ 0,05 was considered significant HB score >5 is defined as active disease. UCDAI score of 3 to 6 is defined as mild, 7 to 10 as moderate and 11 to 12 as severe disease
Mentions: A total of 453 GMA procedures were performed and adequate venous access was achieved in all patients. Thus, no patients were excluded due to inadequate venous access. Out of 40 patients with chronically inflamed mucosa (15 with UC and 25 with CD) and refractory to conventional medications, 34 (85%) responded to GMA. Furthermore, 26 patients, ten with UC and 16 with CD (65%) achieved clinical as well as endoscopic remission for an average of 14 months, ranging from two to 58 months (Figure 1). The laboratory data are summarised in Table 2. HBI- and UC-DAI-outcome, significant when assessed between baseline and 20 weeks follow-up, are displayed as box plots in Figure 2. Data from three patients are missing (UC-DAI and HBI were initiated from the second patient and one CD-patient had ileostoma).

Bottom Line: Fourteen patients who relapsed after showing initial remission were re-treated with GMA and 13 (93%) went into a second remission.Following further relapses, all of seven patients were successfully re-treated for the third time, all of three patients for the fourth time and one for a fifth time.Re-treatment of relapsing remission patients seems to be effective.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset SE-118 83 Stockholm, Sweden.

ABSTRACT

Background: Patients with IBD and chronic inflammation refractory to conventional therapy often demonstrate higher risk of serious complications. Combinations of immunosuppression and biological treatment as well as surgical intervention are often used in this patient group. Hence, there is need for additional treatment options. In this observational study, focused on re-treatment and long-term results, Granulocyte/Monocyte Adsorption (GMA, Adacolumn) treatment has been investigated to study efficacy, safety and quality of life in IBD-patients with chronic activity.

Methods: Fifteen patients with ulcerative colitis and 25 patients with Crohn's disease, both groups with chronically active inflammation refractory to conventional medication were included in this observational study. The patients received 5-10 GMA sessions, and the clinical activity was assessed at baseline, after each completed course, and at week 10 and 20 by disease activity index, endoscopy and quality of life evaluation. Relapsed patients were re-treated by GMA in this follow-up study up to 58 months.

Results: Clinical response was seen in 85% and complete remission in 65% of the patients. Ten patients in the UC-group (66%) and 16 patients in the CD-group (64%) maintained clinical and endoscopic remission for an average of 14 months. Fourteen patients who relapsed after showing initial remission were re-treated with GMA and 13 (93%) went into a second remission. Following further relapses, all of seven patients were successfully re-treated for the third time, all of three patients for the fourth time and one for a fifth time.

Conclusions: IBD-patients with chronic inflammation despite conventional therapy seem to benefit from GMA. Re-treatment of relapsing remission patients seems to be effective.

Show MeSH
Related in: MedlinePlus