Granulocyte and monocyte apheresis as an adjunctive therapy to induce and maintain clinical remission in ulcerative colitis: a systematic review and meta-analysis

Abstract

ObjectiveThe goal of treatment in ulcerative colitis (UC) is to induce and maintain remission. The addition of granulocyte and monocyte apheresis (GMA) to conventional therapy may be a promising therapeutic alternative. In this meta-analysis, we aimed to assess the efficacy and safety profile of GMA as an adjunctive therapy.DesignSystematic review and meta-analysis.MethodsWe searched four databases (MEDLINE, Embase, Web of Science and Cochrane Central Register of Controlled Trials) for randomised or minimised controlled trials which discussed the impact of additional GMA therapy on clinical remission induction and clinical remission maintenance compared with conventional therapy alone. Primary outcomes were clinical remission induction and maintenance, secondary outcomes were adverse events (AEs) and steroid-sparing effect. ORs with 95% CIs were calculated. Trial Sequential Analyses were performed to adjusts for the risk of random errors in meta-analyses.ResultsA total of 11 studies were eligible for meta-analysis. GMA was clearly demonstrated to induce and maintain clinical remission more effectively than conventional therapy alone (598 patients: OR: 1.93, 95% CI 1.28 to 2.91, p=0.002, I2=0.0% for induction; 71 patients: OR: 8.34, 95% CI 2.64 to 26.32, p<0.001, I2=0.0% for maintenance). There was no statistically significant difference in the number of AEs (OR: 0.27, 95% CI 0.05 to 1.50, p=0.135, I2=84.2%).ConclusionGMA appears to be more effective as an adjunctive treatment in inducing and maintaining remission in patients with UC than conventional therapy alone.PROSPERO registration numberCRD42019134050.

Single-cell RNA-sequencing combined with bulk RNA-sequencing analysis of peripheral blood reveals the characteristics and key immune cell genes of ulcerative colitis

“…Previous studies have shown that reduced expression of CD162 is associated with endotoxemia and decreased binding of PLTs to monocytes via membrane CD162-CD62P, which are conducive to the inflammatory response of UC patients[ 21 ]. Not surprisingly, selective granulocyte and monocyte apheresis (GMA) combined with conventional therapy appears to be more effective than conventional therapy alone in inducing and maintaining remission in patients with UC[ 22 , 23 ]. By constructing a WGCNA network, we identified the three core genes of the coexpression network: RhoB, CTSD and ZYX.…”

Adsorptive cytapheresis for ulcerative colitis with focus on removing platelets and platelet‐aggregates

“…From the scientific perspective, this is mainly due to the inconsistent study situation. Although various reviews [8] show an efficacy of apheresis in the induction of remission in more than 70% of the patients, and meta‐analyses even show a superiority in the induction of remission compared with conventional therapy alone [33], the positive experience to date has been gained predominantly from smaller studies in which double‐blind or randomized comparative data are lacking. Only two double‐blind, randomized studies analyzing cytapheresis for the treatment of UC have been conducted to date: While a study by Sawada et al was able to present positive results in 19 patients in the apheresis group with a remission rate of 80% compared with 33% in a sham apheresis group [34], a study by Sands et al showed no significant clinical effect of cytapheresis compared with sham apheresis [35].…”

IBD barriers across the continents – East Asia

“…71,72 Based on the primary goal of CAP to deplete effector cells of the intestinal inflammatory response, this non-pharmacological extracorporeal therapy has been gaining evidence in its efficacy in UC treatment with excellent safety profile. 72–74…”

“…71,72 Based on the primary goal of CAP to deplete effector cells of the intestinal inflammatory response, this non-pharmacological extracorporeal therapy has been gaining evidence in its efficacy in UC treatment with excellent safety profile. [72][73][74] Recently, the AOCC and APAGE practice have jointly published a consensus on medical management and monitoring for IBD in Asia as well. 61 With the development on more structured recommendations, these have shed lights on management targeting the Asia IBD patients.…”