Factors associated with the outcomes in ulcerative colitis patients undergoing granulocyte and monocyte adsorptive apheresis as remission induction therapy: A multicenter cohort study

Abstract

Ulcerative colitis (UC) patients harbor activated myeloid leukocytes, which exacerbate and perpetuate UC by releasing inflammatory cytokines. Granulocyte and monocyte adsorptive apheresis (GMA) with an Adacolumn depletes elevated myeloid leukocytes, inducing efficacy with favorable safety. To understand how the clinical outcome with GMA is affected by prior corticosteroid treatment or concomitant immunomodulators, a retrospective multicenter study in 102 UC patients, who had not responded well to first‐line medications was undertaken. The remission rates after a course of GMA therapy were significantly higher in corticosteroid‐naïve patients compared with those with prior corticosteroid exposure. Absence of corticosteroid background was an independent predictive factor of response to GMA. Further, in corticosteroid‐naïve patients, the 1‐year cumulative sustained remission rate in patients who did not receive immunomodulators was significantly higher than in patients who received immunomodulators. Accordingly, multivariate analysis revealed that immunomodulator was associated with higher risk of relapse. In conclusion, GMA was an effective treatment for corticosteroid‐naïve patients and the efficacy sustained longer in those not receiving immunomodulators during GMA. GMA fulfills the notion that apheresis is to induce disease remission by removing from the body factors known to perpetuate disease. In therapeutic settings, these findings should help better decision making and avoid futile use of medical resources.

Concomitant pharmacologic medications influence the clinical outcomes of granulocyte and monocyte adsorptive apheresis in patients with ulcerative colitis: A multicenter retrospective cohort study

“…The mechanism underlying GMA involves the Adacolumn, which is filled with cellulose acetate (CA) beads, interacting with fragment crystallizable‐gamma receptor (FcγR) expressed at the surface of activated leukocytes and selectively adsorbing granulocytes and monocytes from the systemic circulation 2 . Numerous reports have described the clinical efficacy and safety of GMA in patients with active UC 3‐22 . Previous reports have demonstrated that patients who were most likely to respond to GMA tended to be first attack cases and were steroid‐naïve with short disease duration and low disease activity 9‐14 .…”

Efficacy of cytapheresis in patients with ulcerative colitis showing insufficient or lost response to biologic therapy

“…There were eight studies that evaluated the efficacy of CAP in patients having UC with insufficient response to thiopurines (Table 1 )[ 36 , 37 , 42 , 58 - 62 ]. These studies include three prospective studies, two retrospective studies, one historical cohort study, one single-arm, open-label, multicentre trial, and one multicenter cohort study.…”

“…Regarding the rate of steroid-free remission, two studies[ 59 , 62 ] compared the rates of steroid-free remission between the patients concomitantly treated with thiopurines or IM and the patients treated without them. These studies showed that significant differences were not observed between the patients concomitantly treated with thiopurines or IM and patients treated without them.…”

“…The steroid-free remission rates in patients with UC concomitantly treated with thiopurines or IM were 41.7% and 56.3% (mean: 49%) and the rates of steroid-free remission in patients with UC treated without thiopurines or IM were 45.5% and 53.5% (mean: 49.5%), respectively (Figure 2B ). Specifically, Ishiguro et al [ 62 ] showed that in the univariate analysis, IM therapy was not associated with remission induction rate by GMA ( P = 1.00). However, they also showed that in the multivariate analysis, only IM therapy was associated with an increased risk of relapse (OR: 37.6877, 95%CI: 2.4178-587.4632; P = 0.0013).…”

“…The purpose of this article is to summarize the current literature on the use of CAP as an alternative therapeutic strategy for patients with UC showing insufficient response or LOR to biologics and discuss the advantages and limitations of this strategy. We also summarized the efficacy of CAP for patients with UC showing insufficient response to thiopurines or immunomodulators (IM)[ 36 , 37 , 42 , 58 - 62 ].…”