Improved response to infliximab after leukocytapheresis in a patent with rheumatoid arthritis

Abstract

This is the first report on effective leukocytapheresis (LCAP) in an acquired infliximab (IFM) resistant patient with rheumatoid arthritis (RA). A 44-year-old Japanese woman with RA was treated with prednisolone, cyclosporine A, and methotrexate, which failed to stabilize the disease. Infliximab was then administered and the disease activity was controlled on December 2003. However, RA became active again on June 2004 so that LCAP was administered weekly for 5 weeks. After the LCAP treatment, the ACR20% response was obtained again and IFM has regained its efficacy.

Safety and efficacy of the leukocytapheresis procedure in eighty-five patients with rheumatoid arthritis

“…The effects persisted even after treatment completion, with CRP level showing tendency to decrease through 4 weeks after LCAP completion. LCAP thus represented a beneficial treatment for RA, and the results of this study were not inconsistent with those of previous studies [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. In this study, patients showed high disease activity prior to LCAP initiation.…”

“…No other noteworthy serious adverse events were seen in our study. Though fever (n=2), headache (n=2), nausea (n=1), and blood pressure decrease (n=1) have occurred, these symptoms were usually transient as reported previously [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. (Table3) Of 85 patients who underwent LCAP treatment in this study, 51 patients achieved ACR20 at the completion of 5 treatment and they were considered as responders.…”

“…Improvement was evaluated using the DAS28 and EULAR improvement criteria. We evaluated efficacy until 4 weeks after the completion of treatment, because it had shown that disease activity of responders improved by 4weeks after the completion [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. If their disease activity have gotten worse while observation period, we have to add other medication ethically.…”

“…LCAP does not have severe side effects associated with traditional immunosuppression regimens which make this therapy an effective alternative strategy for RA treatment when conventional DMARDs and immunosuppressants cannot be used. Sporadic reports have suggested the efficacy of LCAP in treating such refractory patients (Table 1) [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20].…”

Efficacy of High‐Throughput Leukocytapheresis for Rheumatoid Arthritis With a Reduced Response to Infliximab

“…In a report by Azuma et al., LCAP was performed a total of five times at a frequency of once a week using a CS‐100 with 3000 mL whole blood in a 44‐year‐old male RA patient with a reduced response to INF, 5 months after starting INF therapy. Decreased CRP, decreased tender/swollen joint counts, decreased DAS28‐CRP, and achievement of ACR20 were noted 1 week after completion of LCAP (14). Although the mechanism of action is unknown, the response to INF might have been restored by a decrease in the volume of TNFα‐producing cells and TNFα in the synovium due to LCAP‐induced redistribution of granulocytes and lymphocytes from the peripheral blood.…”