Granulocyte-Monocyte Apheresis in Steroid-Dependent, Azathioprine-Intolerant/Resistant Moderate Ulcerative Colitis: A Prospective Multicenter Study

Abstract

Background Granulocyte-monocyte apheresis has been proposed for the treatment of ulcerative colitis, although it is limited by costs and variability of results. Aim To assess effectiveness of granulocyte-monocyte apheresis in patients with steroid-dependent, azathioprine-intolerant/resistant moderate ulcerative colitis. Methods Consecutive patients fulfilling inclusion criteria were prospectively enrolled, treated by apheresis, and followed up for 12 months. The primary end point of the study was steroid-free clinical remission at 12 months, with no need for biologic therapy or surgery. Results From January to December 2013, 33 patients were enrolled. After one year of follow-up, 12 (36%) patients had clinical remission, were steroid-free, and had no need for biological therapy or surgery; 3 (9%) cases showed a clinical response (but not clinical remission). Moreover, 12 (36%) patients required biologic therapy, 4 (12%) underwent colectomy, and in the other 2 (6%) a reduction, but not withdrawal, of steroid dose was achieved. Conclusions Our study shows that a standard course of granulocyte-monocyte apheresis is associated with a 36% steroid-free clinical remission in patients with steroid-dependent, azathioprine-intolerant or resistant moderate ulcerative colitis. Apheresis might represent an alternative to biologic therapy or surgery in this specific subgroup of patients. This trial is registered with Clinicaltrial.gov NCT03189888.

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

“…These results are in line with the outcomes in a previous study had sustained clinical remission rates of 83.3%, 68.8%, and 23.1% in corticosteroid‐naïve, corticosteroid‐dependent, and corticosteroid‐refractory patients, respectively 12 . Further, as remission‐induction therapy, GMA has shown efficacy in immunomodulator‐intolerant or refractory moderate UC patients 31–39 . However, more recent studies have shown that concomitant IMM therapy may compromise a patient's response to GMA in the maintenance phase 13,40 .…”

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 .…”

“…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 . However, GMA has been reported to enable the evaluation of clinical efficacy for refractory UC such as steroid‐dependent UC and immunosuppressor (IM)‐resistant UC 6,15,16 . Moreover, recent studies have described the combined efficacy of GMA with biologics 17,20 and tofacitinib 21 in patients with refractory UC.…”

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

“…A few recent retrospective and prospective studies have suggested certain prognostic factors in the therapeutic response. [35][36][37] It seems that younger patients respond better to GMA therapy, whereas gender and smoking status showed no difference in response to treatment. 35 Yokoyama et al found that shorter duration of UC and lower cumulative corticosteroid dose are associated with a higher efficacy rate.…”

“…[35][36][37] It seems that younger patients respond better to GMA therapy, whereas gender and smoking status showed no difference in response to treatment. 35 Yokoyama et al found that shorter duration of UC and lower cumulative corticosteroid dose are associated with a higher efficacy rate. 36 In their study, patients who received GMA treatment immediately after relapse were the best responders.…”