Clinical Effectiveness of Selective Granulocyte, Monocyte Adsorptive Apheresis with the Adacolumn® Device in Ulcerative Colitis

Abstract

The purpose of this meta-analysis was to determine whether selective adsorptive granulocyte and monocyte apheresis (GMA apheresis) using the Adacolumn device can effectively reduce clinical symptoms and endoscopic signs of inflammation in patients with ulcerative colitis (UC). A comprehensive search for randomized controlled trials (RCTs) published up to May 2008 was performed. Each study's quality was evaluated, and the data reported in the results were abstracted. Pooled relative risk (RR) estimates and 95% confidence intervals (CIs) were calculated using the fixed-effects model. Heterogeneity was quantified statistically and explained by the variation in the trial design. Seven RCTs including 594 patients were found, and six RCTs on active UC contributed to the main analyses. In half of the trials, GMA apheresis was compared to steroids. Only one trial was fully blinded. A response or remission after 6 weeks was achieved more often in patients treated with GMA apheresis (RR 1.42; CI 1.15-1.75). Also, after 12 weeks, GMA apheresis produced significantly higher remission rates (RR 1.41; CI 1.08-1.83), but long-term data were sparse. In the trials that compared GMA apheresis and steroids (n = 220 patients), side effects were much less frequent in the GMA apheresis groups (RR 0.19; CI 0.11-0.34). Homogeneous evidence from seven RCTs shows that GMA apheresis induces a clinical remission in a higher proportion of UC patients as compared to conventional medical therapy.

Selective Granulocyte and Monocyte Apheresis as a Non-Pharmacological Option for Patients with Inflammatory Bowel Disease

“…The same conclusion was drawn in a review from Habermalz and Sauerland [49]. More patients responded to GMA than to an increase in steroid dosage.…”

Clinical trial: five or ten cycles of granulocyte–monocyte apheresis show equivalent efficacy and safety in ulcerative colitis

“…22 Furthermore, the incidence of side effects was approximately 80% lower with apheresis than steroids. Others have also shown that dosages of concomitant steroid can subsequently be tapered or discontinued following apheresis.…”

Advantages of Fecal Lactoferrin Measurement during Granulocyte and Monocyte Adsorptive Apheresis Therapy in Ulcerative Colitis

“…GMA therapy has been reported as an effective therapy with minimal side effects for patients with UC, particularly in refractory cases to conventional drug therapy [8,14,16,17,18,19,20,21]. In contrast, a study in the United States reported no significant difference between the sham group and the GMA group [45].…”

“…GMA is also associated with marked increase in serum level of the anti-inflammatory cytokine, IL-10 [15]. Several studies have reported significant efficacy in patients with UC following a course of GMA [8,14,16,17,18,19,20,21]. It has been reported that the overall response (remission or significantly improvement) of GMA treatment increased from 58.5 to 77.7% [14,18,20].…”

“…It has been reported that the overall response (remission or significantly improvement) of GMA treatment increased from 58.5 to 77.7% [14,18,20]. Meta-analysis has also revealed that GMA induced a clinical remission in a higher proportion of patients with UC compared with conventional medical therapy from seven randomized controlled trials [19]. One of the advantages of GMA treatment is the lower frequency of side effects compared to steroid treatment [14,18].…”