RESEARCH - A multicenter study of leukocytapheresis in RA

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Clin Exp Rheumatol. 2007 Nov-Dec;25(6):810-6.

A multicenter study of leukocytapheresis in rheumatoid arthritis.

Ueki Y, Sagawa A, Tanimura K, Yamada A, Yamamoto K, Tsuda H, Tohma S,

Suzuki K, Tominaga M, Kawabe Y, Mine M, Honda S, Tsukano M, Nakamura

T, Hidaka T, Eguchi K.

Rheumatic and Collagen Disease Center, Sasebo Chuo Hospital, The

University of Tokyo, Sasebo, Japan.

OBJECTIVE:To evaluate the efficacy and safety of leukocytapheresis

(LCAP) in patients with rheumatoid arthritis (RA) that is refractory

to disease modifying antirheumatic drugs (DMARDs), we conducted a

prospective, multicenter, open-label clinical trial.

METHODS:We enrolled 38 active RA patients, including 32 patients who

showed an inadequate response to > or = 2 DMARDs and 6 patients with

rapidly progressive RA. All patients continued drug therapy and were

treated with 5 LCAP sessions conducted at 1-week intervals. The

clinical response was evaluated at baseline before starting LCAP and

at 4 weeks after the completion of all the LCAP sessions using the

American College of Rheumatology (ACR) criteria and the 28-joint

disease activity score (DAS28) of the European League Against

Rheumatism (EULAR).

RESULTS:Of the 35 patients who fulfilled the study's eligibility

criteria, 24 (69%), 10 (29%), and 23 (66%) patients achieved 20%

(ACR20), 50% (ACR50), and DAS28-C-reactive protein (CRP) EULAR

improvement, respectively. The mean DAS28-CRP score of the 35 patients

decreased significantly from 5.99 +/- 0.92 at baseline to 4.54 +/-

1.39 after treatment. Comparison analysis of the ACR20 responders and

non-responders to LCAP revealed that 22 of 24 responders (92%)

concomitantly received methotrexate, whereas significantly fewer, that

is, 6 of 11 non-responders (55%) received methotrexate. Less frequent

and transient mild-to-moderate adverse events, including nausea and

headache, were seen in 12 of 189 LCAP sessions (6.3%).

CONCLUSION:These results demonstrate the usefulness of LCAP in

combination with DMARDs, particularly methotrexate, as an effective

and safe treatment for refractory RA.

PMID: 18173913

http://www.ncbi.nlm.nih.gov/pubmed/18173913

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