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EFFICACY AND SAFETY OF GRANULOCYTOAPHERESIS IN THE TREATMENT OF STEROID-DEPENDENT AND STEROID-REFRACTORY INFLAMMATORY BOWEL DISEASE

Nelson Daniel Salazar Parada 1, Maria Algara San Nicolas 1, Ana Suárez-Saro Fernández 1, Nelson Daniel Salazar Parada 1, Nelson Daniel Salazar Parada 1, Nelson Daniel Salazar Parada 1, Nelson Daniel Salazar Parada 1, Nelson Daniel Salazar Parada 1

Affiliations

1 Hospital Universitario 12 de Octubre, Madrid, Spain

Summary

AI Generated

A retrospective cohort study of 49 patients with steroid-dependent or steroid-refractory IBD treated with granulocytoapheresis found response rates of 75% after induction in ulcerative colitis and 58% in Crohn's disease, with no major adverse events.

In 37 ulcerative colitis patients, 75% responded after induction (5 cycles over 3 weeks), and 67% of those continuing maintenance (at least 10 cycles over 6 months) responded, with mean CRP declining from 3.16 to 1.15 mg/dl and calprotectin from 2038 to 900 mg/dl.
In 12 Crohn's disease patients, 58% responded after induction and 50% of those on maintenance responded, with mean CRP declining from 3.16 to 1.14 mg/dl and calprotectin from 3645 to 623 mg/dl.
Most patients (67.7% of UC, 67.7% of CD) had received at least one prior biologic treatment, and response was not significantly related to smoking, disease extent, disease duration, or prior treatment failures.
No major adverse events were recorded in any patient during the study period.
The authors conclude that granulocytoapheresis appears safe and effective for induction and maintenance in steroid-refractory or steroid-dependent IBD, particularly in ulcerative colitis.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Despite the importance of granulocytoapheresis (GCA) in the treatment of inflammatory bowel disease (IBD), its effectiveness in steroid-dependent and steroid-refractory IBD has not been widely evaluated, the approaches are heterogeneous and data on efficacy and safety remain limited in our population.

Aims & Methods

This study aims to assess the effectiveness of GCA for induction of remission and maintenance in patients with steroid-dependent and steroid-refractory IBD in the real-world practice.
Retrospective cohort of patients with steroid-dependent and steroid-refractory colonic IBD, in which GCA was used as induction of remission and maintenance treatment between January-2015 to January-2023. We analyze demographics, disease characteristics, prior exposure including biologic agents. The success of GCA was defined on a decrease of at least 3 points in the True-love score for Ulcerative Colitis (UC) and a decrease of at least 100 points in the CDAI for Crohn Disease (CD).
To analyze predictive factors of treatment success we performed a univariate and multivariable analysis.

Results

49 patients were included. 5 cycles of apheresis were performed in the first 3 weeks as induction and at least 10 cycles of apheresis as maintenance in the next 6 months.
75 % (37 / 49) had UC, 86.4 % (32 / 37) were steroid-refractory while 13.6 % (5 / 37) steroid-dependent, 54 % (20 / 37) male; median age 60 ± 10.5 years with a mean of 10.5 years from diagnosis. 67.7 % (25 / 37) had received at least 1 biological treatment in the past, 43.5 % (17 / 39) ≥ 2 biological. After induction, 75 % (28 / 37) responded to treatment, 62 % (23 / 37) continued with maintenance therapy of which 67 % (15 / 23) responding. Mean PCR and calprotectin were 3,16 mg / dl and 2038 mg / dl before treatment, 1.45 mg / dl and 1025 mg / dl after induction, 1.15 mg / dl and 900 mg / dl after maintenance, respectively.
25 % (12 / 49) had CD, 50 % (6/12) male; median age 62 ± 9.8 years, 75 % (9 / 12) steroid-refractory and 25 % (3 / 12) steroid-dependent, with a mean of 9 years from diagnosis, 67.7 % had received at least one biological treatment in the past. After induction, 58 % (7 / 12) responded, 80 % (10 / 12) continued with maintenance with 50 % (5 / 10) responding. Mean CRP and calprotectin were 3.16 mg / dl and 3645 mg / dl before treatment, 1.7 mg / dl and 2473 mg / dl after induction, 1.14 mg / dl and 623 mg / dl after maintenance.
Factors such as smoking, extent of disease, longer disease course and lack of response to previous treatments, were not significantly related to response in either induction or maintenance.
No patient had major adverse events recorded.

Conclusion

GCA appears to be safe and effective for inducing and maintaining clinical remission in patients with IBD, especially in patients with UC. No significant differences were found in disease extension, duration or lack of response to previous treatments.

Conference

UEG Week Copenhagen 2023

Topics

IBD

Submission format

Abstract

Session

PP 05 IBD (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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