Efficacy and Safety of Adsorptive Granulocyte and Monocyte Apheresis in Elderly and Pregnant Patients With Ulcerative Colitis

Abstract

In patients with active ulcerative colitis (UC), adsorptive granulocyte/monocyte apheresis (GMA) is expected to promote remission. We conducted a retrospective cohort study to evaluate the efficacy and safety of GMA in patients with active UC. Twenty‐one UC patients including five pregnant or lactating mothers and four elderly patients (aged >60 years) received up to 10 GMA sessions. UC severity was evaluated at baseline and after GMA therapy according to Lichtiger's Clinical Activity Index (CAI). We defined clinical remission as CAI ≤4. Overall, the median CAI score after GMA therapy had decreased from 9 to 4 (P < 0.001). The clinical remission rate was 62%, but in the elderly and pregnant or lactating mothers, the remission rates were 100% and 60%, respectively. No severe adverse effects were seen in this study. Our results may support GMA as an effective and safe treatment for active UC patients, including elderly patients and pregnant cases.

Adsorptive cytapheresis in ulcerative colitis: A non‐pharmacological therapeutic approach revisited

“…The overall occurrence of AE in elderly patients is slightly higher than that of adults (OR 1.3, CI 0.61‐2.79) 48 . As the prevalence of mild and moderate AE is comparable to that observed in younger age groups, the observed difference is due to 5% occurrence of serious AE, largely related to pre‐existing comorbidities 47,48,57,67,68 …”

“…48 As the prevalence of mild and moderate AE is comparable to that observed in younger age groups, the observed difference is due to 5% occurrence of serious AE, largely related to pre-existing comorbidities. 47,48,57,67,68 GMA and LCAP are safe in pediatric patients, but technical difficulties, consisting in blood access problems or pain at the infusion site, more often occur in children than in adults. 50,51,69 Transient headaches and nausea have occasionally been reported in children and the few pregnant women treated with AC.…”

“…50,51,69 Transient headaches and nausea have occasionally been reported in children and the few pregnant women treated with AC. 52,53,68,70 Thus, available evidence indicates that the occurrence of clinically relevant AE is extremely low, and the procedure can be considered safe in all age groups as well as in patients with concomitant comorbidities.…”

“…GMA and LCAP are safe in pediatric patients, but technical difficulties, consisting in blood access problems or pain at the infusion site, more often occur in children than in adults 50,51,69 . Transient headaches and nausea have occasionally been reported in children and the few pregnant women treated with AC 52,53,68,70 …”

Intensive Frequent Granulocyte Adsorptive Apheresis Therapy for Acute Fulminant Ulcerative Colitis: Two Consecutive Case Reports

“…This therapy is characterized by fewer side effects and greater effectiveness than steroids [1,2]. Moreover, the efficacy and safety of GMA have been demonstrated in older and pregnant patients with UC [3]. Herein, we describe two consecutive cases of acute fulminant UC, wherein rapid remission was achieved with intensive frequent GMA therapy administered 10-11 times within two weeks.…”