P0592 SAFETY AND EFFICACY OF LEUKOCYTE APHERESIS IN CHILDREN WITH TREATMENT-RESISTANT IBD

Le résumé fourni par la source

Introduction: Active inflammatory bowel disease is characterised by activation and infiltration of granulocytes and monocytes into the bowel mucosa.These release proinflammatory cytokines and proteases causing mucosal damage.Leukocyte apheresis has been shown to be effective in adults and children with UC(1,2).Adacolumn is an adsorptive leukocyte apheresis device.Pre and post column leukocyte counts have shown that the carriers absorb 65% of granulocytes, 55% of monocytes and 2% of lymphocytes(3).We evaluated safety, tolerability and efficacy of leukocyte apheresis using Adacolumn in paediatric patients with treatment-resistant IBD. Methods: Children (10–17y) were recruited (Oct 03-) in a 12 patient safety and tolerability study.Children were only offered treatment if resistant to all conventional medical therapies i.e. before referral for surgery.Treatment included five apheresis episodes over 5 weeks. Efficacy was measured by clinical activity indices and physician and parent global assessment scores. In addition to standard parameters, T & B cell populations and lymphocyte activation markers were monitored before and after therapy. Results: 4 children (mean 14.5y) were enrolled, with 14 completed apheresis episodes. All had severe disease at screening. One patient received no treatment due to failure of venous cannulation. Three SAEs were reported. All were due to disease exacerbation and unlikely related to the intervention. Ten adverse events were recorded; 5 possibly due to the treatment (fever (4), vomiting (1)). One patient (UC) achieved a clinical remission at 7 weeks after enrolment. Two children with exacerbations of Crohn’s disease received Infliximab after the 5th apheresis episode in preparation for colectomy. Scores of tolerability for physician and patient were 8.4 & 7.6/10 respectively. There was a reduction in B and NK cell numbers by the 4th and 5th treatment. Conclusion: Leukocyte apheresis can offer a safe, well-tolerated adjunct to conventional therapy in paediatric patients with severe inflammatory bowel disease.It may also prove efficacious in achieving disease remission.Further studies are needed to define its role in management and maintenance of remission.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.