ABSTRACT
Adacolumn, it is a medical device recently introdcuced into clinical
practice; allows a selective depletion of circulating leucocytes, in particular granulocytes and macrophages-monocytes, which are considered the main responsible of the inflammatory process in the inflammatory bowel disease (IBD).
The main indications to the treatment are dependent and steroid-refractory patients with moderate to severe active disease unresponsive to conventional therapy.
AIM
The aim of this study was to evaluate the leucocyteapheresis's effectivness in patients with moderate to severe IBD, unresponsive to conventional therapy.
METHOD AND PATIENTS
We studied fiftyfour patients with moderate to severe IBD unresponsive to conventional therapy, 39 affected by Crohn disease (CD) and 15 by
ulcerative colitis (UC); they were followed at the U.O. of
Gastroeneterology Universitary of Pisa and U.O. Gastroeneterology and Metabolism diseases.
Patients underwent one session per week of leucocyteapheresis with Adacolumn for a total of five weeks.
column filled with 35,000 cellulose acetate beads (each with a diameter of 2 mm): it is prepared before treatment with 1 L of isotonic saline solution and 4000UI of eparine; the Adacircuit that connects the column to the patient via two venous accesses: the blood is pumped out of the arm
“donor” into the column and then returns to arm“receiving”; each session lasts 60 minutes and the perfusion rate is 30 ml/minutes: a total volume of 1,8 L of blood is perfused.
All the patients had moderate to severe disease, defined on the basis of the Ulcerative Colites Activity Index (UCAI) and Crohn Disease Activity Index (CDAI), rispectively for UC and MC.
Each patients, before and three months after cessation of treatment, underwent a specialistic visit during which UCAI and CDAI where calculated and serological flogistic markers were measured (in particular ESR and CPR).
RESULTS
The leucocyteaphersis treatment was effective in inducing remission in patients with moderate to severe IBD unresponsive to conventional
therapy: there was a statistically significant decrease both disease clinical activity index (CDAI,UCAI) and markers of inflammation (ESR,CRP).
CONCLUSIONS
The leucocyteapheresis it is certainly promising in the treatment of
disease .
The device also proved to be safe and without severe side effects. However will be require studies with a larger population and a longer follow-up period to allow a long- term assessment.
