Sands BE et al. (2006) Pilot feasibility studies of leukocytapheresis with the Adacolumn apheresis system in patients with active ulcerative colitis or Crohn disease. J Clin Gastroenterol 40: 482–489

Preliminary studies suggested that selective removal of circulating granulocytes and monocytes, with the Adacolumn® (Japan Immunoresearch Laboratories, Takasaki, Japan) apheresis system, could ameliorate IBD symptoms. Two pilot studies undertaken in seven US centers have now provided fresh evidence that this treatment is safe and effective in patients with moderate-to-severe, treatment-refractory IBD. Sands et al. say that Adacolumn® leukocytapheresis could become a useful adjunct therapy for patients with IBD who cannot tolerate or who do not respond to conventional pharmacotherapy.

Each study enrolled 15 patients, with either ulcerative colitis or Crohn's disease, respectively. All patients had active, moderate-to-severe disease of ≥3 months duration that had not responded to conventional medications; seven patients with Crohn's disease had previously undergone surgery. Patients were scheduled to undergo five 60 min Adacolumn® sessions at weekly intervals, and were followed up in weeks 7, 12, and 16. In all, 11 of 15 patients with ulcerative colitis and 14 of 15 patients with Crohn's disease received five Adacolumn® treatments. At week 7, five patients with ulcerative colitis and nine with Crohn's disease had responded, with clinically meaningful reductions in disease activity. Six of these nine Crohn's disease patients entered remission. There were no serious treatment-related adverse effects.

The authors note that good venous access is essential for successful Adacolumn® treatment, and conclude that adequate training of apheresis operators is a key factor. Larger, sham-treatment-controlled trials are ongoing.