Efficacy and Effective Endoscopic Findings of Granulocyte and Monocyte Absorption Apheresis (GCAP) and Leukocytapheresis (LCAP) Therapy in Patients with Refractory Active Ulcerative Colitis (UC)

Abstract

Background: UC is a chronic inflammatory bowel disease of unknown etiology. Frequent relapse often results in long-term medication and impaired quality of life of the patients. Recently it has been proved that GCAP and LCAP are effective and safe for patients with moderate to severe UC. Aim: The aim of the present study is to prove efficacy and endoscopic findings of GCAP and LCAP in active UC patients, especially in refractory and steroid-dependent cases. Subjects and methods: Active UC patients (Mean age 39.8; Duration of the disease 5.6 years; 19 male, 9 female; 24 total colitis, 4 left-sided colitis; 18 refractory to conventional therapy and 7 steroid dependent) were treated with GCAP (n=18) or LCAP (n=10). The patients received one or two GCAP/LCAP session per week for 5 consecutive weeks. And the patients received colonoscopy before and after GCAP/LCAP session. Results: About 68 % of the patients achieved clinical response, and no severe adverse-effects were observed. Most of steroid-dependent patients or patients who had side-effect due to steroid (6 osteoporosis, 3 diabetes, 1 compression fracture of lumbar vertebra, 1 femoral bone necrosis, 1 schizophrenia, 1 erythema nodosum) were successfully controlled. Seven patients underwent scheduled colectomy for future exacerbation of the disease in remission stage and one patient with semi-emergent operation. Endoscopically, 12/14 cases with shallow ulcers and erosion throughout the colon and 7/12 with deep ulcerations responded to the treatment, however, 2 with massive ulceration of whole mucosa did not respond. Conclusion: GCAP/LCAP were valuable therapies for refractory or steroid-dependent patients, and endoscopic findings are helpful in expecting clinical effectiveness.