Apheresis contributes to remission in children with new onset IBD colitis

Last Updated: 2017-07-27

By Will Boggs MD

NEW YORK (Reuters Health) - Granulocyte and monocyte apheresis (GMA) contributes to the induction of remission in children newly diagnosed with inflammatory bowel disease (IBD) colitis, researchers from Sweden report.

The efficacy of GMA for remission treatment in new onset IBD colitis is "most interesting and slightly unexpected," Dr. Helena Jonsson Rolandsdotter from Karolinska Institutet, Stockholm, told Reuters Health by email. "I was surprised by the results of clinical follow-up (not fully published) that show that a majority . . . of the children who remitted stayed in remission for a long time on single aminosalicylate (5-ASA) treatment, although they had extensive or total colitis."

Standard first-line treatment for these children is exclusive enteral nutrition, though 5-ASA is used to induce remission in selected Crohn's disease patients with colonic inflammation. GMA, which selectively removes innate immune cells that are the main producers of pro-inflammatory cytokines, has been used as a last treatment option.

Dr. Rolandsdotter's team conducted a pilot study of GMA treatment in combination with low-to-moderate dose 5-ASA (mesalazine) as first-line therapy in 13 children and adolescents with new-onset extensive IBD colitis.

Twelve patients underwent all 10 GMA sessions, with none showing a worsening of symptoms during the treatment period, according to the June 9th Journal of Pediatric Gastroenterology and Nutrition online report. The other patient experienced severe worsening of symptoms after 5 GMA sessions and left the study when admitted to the hospital.

Twelve weeks after the final GMA treatment, eight patients were in remission, two showed mild disease, and two showed severe disease. Patients who improved did so regardless of initial Pediatric Ulcerative Colitis Activity Index.

Average Mayo scores, a measure of mucosal healing, improved from 1.75 at baseline to 0.75 at post-treatment colonoscopy. Nine patients achieved endoscopic significant remission, and two were in complete histological remission.

Among 10 patients followed for 34-48 months, five still used the initially prescribed mesalazine but never required any supplemental IBD medication, including corticosteroids.

Three children were treated with prednisolone due to a flare between GMA and the final endoscopy, and one additional child received prednisolone due to a flare several months after the endoscopy. Overall, four patients received azathioprine as maintenance treatment.

"Presently, GMA is used as last resort treatment," Dr. Rolandsdotter said. "It may be that it should be used at an earlier stage, and perhaps as primary remission treatment instead of corticosteroids. To avoid corticosteroids is especially important in children, in whom steroid side effects may be prolonged and harmful, and perhaps even hamper intellectual capacity."

"A randomized controlled trial comparing head-to-head GMA versus corticosteroid treatment for remission in new IBD colitis should be performed," she said.

SOURCE: http://bit.ly/2w3G1Fb

J Pediatr Gastroenterol Nutr 2017.