| Extracorporeal photopheresis (ECP) in patients with steroid-dependent Crohn's disease: An open-label, multicenter, prospective trial. | |
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MedLine Citation:
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PMID: 22573600 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND: Extracorporeal photopheresis (ECP) involves ex vivo leukocyte treatment with methoxsalen and UVA light to generate a tolerogenic response. A previous trial demonstrated that ECP permits corticosteroid withdrawal in steroid-dependent Crohn's disease (CD) patients who were in clinical remission. We studied the effect of ECP on steroid withdrawal in steroid-dependent CD. METHODS: Patients with CD for ≥6 months, in remission at baseline while on steroids, but who had failed at ≥1 steroid withdrawal were included. Patients received two ECP treatments every 2 weeks for the 24-week steroid tapering period and underwent steroid-tapering. Patients completing steroid tapering could receive maintenance ECP (two treatments/week) every month for 24 weeks. RESULTS: Thirty-one patients (Crohn's Disease Activity Index [CDAI] score 91; Inflammatory Bowel Disease Questionnaire [IBDQ] 172.5) were enrolled (baseline corticosteroid dose, 20 mg/day); 65% were refractory to/intolerant of anti-tumor necrosis factor (TNF) agents or immunosuppressants. After 24 weeks of ECP, 7 of 31 (22.6%) patients discontinued steroids while maintaining a CDAI of <150. At week 24, the steroid dose for the remaining patients on corticosteroids was 10 mg (P < 0.003 vs. baseline) with a CDAI of 110 and an IBDQ of 179. Following maintenance treatment, three patients remained in steroid-free remission. The 10 patients in the study and receiving ECP at week 48 had a steroid dose of 3.5 mg with a CDAI of 40 and an IBDQ of 188. CONCLUSIONS: ECP permitted discontinuation or reduction of steroids in a population of refractory steroid-dependent CD patients. ECP may be useful in permitting steroid withdrawal in selected steroid-dependent CD patients. Ideally, these results need to be confirmed in a "sham-controlled" clinical trial. (Inflamm Bowel Dis 2012;). |
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Authors:
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Walter Reinisch; Robert Knobler; Paul J Rutgeerts; Thomas Ochsenkühn; Frank Anderson; Christian von Tirpitz; Martin Kaatz; C Janneke van der Woude; Dennis Parenti; Peter J Mannon |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-5-9 |
Journal Detail:
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Title: Inflammatory bowel diseases Volume: - ISSN: 1536-4844 ISO Abbreviation: - Publication Date: 2012 May |
Date Detail:
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Created Date: 2012-5-10 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9508162 Medline TA: Inflamm Bowel Dis Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2012 Crohn's & Colitis Foundation of America, Inc. |
Affiliation:
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Medical University of Vienna, Vienna, Austria. walter.reinisch@meduniwien.ac.at. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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