ORIGINAL ARTICLE

Enhanced effect of high-dose leukocytapheresis using a large filter in rheumatoid arthritis

Authors

Katsumi Eguchi¹, Kazuyoshi Saito², Masakazu Kondo³, Toshihiko Hidaka⁴, Yukitaka Ueki⁵, Yoshiya Tanaka² and LCAP Investigators in Kyushu College of Rheumatology (LIKCR)¹

1. First Department of Internal Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
2. First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan
3. Kondo Clinic of Rheumatology and Orthopedic Sugery, Fukuoka, Japan
4. Institute of Rheumatology, Zenjinkai Shimin-No-Mori-Hospital, Miyazaki, Japan
5. Sasebo Chuo Hospital, Sasebo, Japan

Received:

07 March 2007

Accepted:

01 August 2007

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Abstract

To evaluate the efficacy of high-dose leukocytapheresis (LCAP) using a large filter in patients with refractory rheumatoid arthritis (RA), we conducted a multicenter, nonrandomized, open-label clinical study. Thirty patients with highly active RA were treated with high-dose LCAP performed 3-5 sessions at 1-week intervals using a CS-180S filter (CS-180S group); the treatment involves the removal of leukocytes from a higher blood volume per body weight (100^Sml/kg). The clinical response was evaluated at 4 and 8 weeks after a series of LCAP using the 28-joint disease activity score (DAS28). Similar data of 53 patients treated with conventional LCAP (60^Sml/kg) using a standard filter, CS-100, were compared as a control (CS-100 group). The CS-180S filter demonstrated a higher adsorption capacity for leukocytes, particularly lymphocytes. The CS-180S group exhibited significant improvements in each item of DAS28 after treatment although the CS-100 group did not demonstrate such improvements in the CRP level and the ESR. Compared to the CS-100 group, the patients of the CS-180S group exhibited a tendency toward improvement with respect to the CRP level and ESR (P = 0.057 and 0.041, respectively). According to the EULAR improvement criteria based on DAS28, 60% and 45% of the patients from CS-180S and CS-100 groups achieved moderate or more responses, respectively, at 4 weeks after treatment. These results suggest that compared to conventional LCAP, high-dose LCAP may enhance the suppression of RA disease activity.

Key words

Extracorporeal circulation - Leukocytapheresis - Rheumatoid arthritis