Granulocytapheresis in patients with refractory ocular Behcet's disease

Abstract

Intraocular inflammation (uveoretinitis) is one major complication of Behcet's disease (BD) and responds poorly to drug therapy. This open prospective study was to assess the efficacy of selective granulocytapheresis in patients with refractory uveoretinitis of BD. Fourteen patients aged 20-56 years were treated. Granulocytapheresis was done with an Adacolumn filled with cellulose acetate leucocyte carries or beads that adsorb granulocytes and monocytes from the blood in the column. Each patient received 5 Adacolumn sessions at one session/week over 5 consecutive weeks. The study was designed to allow each patient to serve as his or her own control. The total numbers of ocular attacks (OA) were monitored for 6 months before and after 5 Adacolumn sessions. The number of OA (mean +/- SD) per patient for the 6 months before Adacolumn was 4.21 +/- 1.6 and for the 6 months post Adacolumn was 2.93 +/- 1.39 ( P = 0.0275). Nine patients (64%) improved and 5 did not change or worsened. Further, for a sub-group (n = 7) with duration of BD > or =5 years, the number of OA were 4.71 +/- 1.89 for the first 6 months and 2.29 +/- 1.38 for the second 6 months ( P = 0.0054). The corresponding values for a sub-group (n = 7) with duration of BD<5 years were 3.71 +/- 1.25 and 3.57 +/- 1.13, indicating that patients with long duration of BD are better responders. We conclude that granulocytapheresis might be effective and safe for patients with refractory ocular BD. Further studies are necessary to fully evaluate the clinical efficacy of granulocytapheresis for BD.

Ocular Involvement

“…This therapy is approved in Japan as therapy for ulcerative colitis and Crohn's disease, and with it, the mean frequency of ocular attacks in ocular BD patients has been signifi cantly reduced [ 103 ]. Although it lacks dramatic effects, the advantage of this therapy is the absence of severe side effects.…”

A Major Review: Current Aspects of Ocular Behçet's Disease in Japan

“…39 Although lacking dramatic effect, the advantage of this therapy is the absence of severe side effects.…”

Critical updates in the 7th edition of the American Society for Apheresis guidelines

“…The disease affects a variety of organ systems, such as the eye, brain, and gastrointestinal (GI) tract. BD is most common in Asia, in people with HLA B51, and is a major cause of blindness in patients that suffered repeated attacks …”

“…For BD, both adsorption granulocytaphersis (AG) and TPE remain options, and are category II and III indications, respectively. AG acts by reducing the inflammatory response, whereas the therapeutic effect of TPE is attributed to removing immune complexes …”