Induction of mucosal healing by intensive granulocyte/monocyte adsorptive apheresis (GMA) without use of corticosteroids in patients with ulcerative colitis: long-term remission maintenance after induction by GMA and efficacy of GMA re-treatment upon relapse

Abstract

This study examined the long-term maintenance rate after inducing remission by intensive granulocyte/monocyte adsorptive apheresis (GMA) without use of corticosteroids (CS) and GMA re-treatment efficacy in the same patients upon relapse with ulcerative colitis. Patients who achieved clinical remission and mucosal healing (MH) by first-time intensive GMA (first GMA) without CS were enrolled. The cumulative non-relapse survival rate up to week 156 was calculated. Patients with relapse during the maintenance period underwent second-time intensive GMA (second GMA) without CS. Clinical remission and MH rates following second GMA were compared to those following first GMA in the same patients. Of the 84 patients enrolled, 78 were followed until week 156 and 34 demonstrated relapse. The cumulative non-relapse survival rate by week 156 was 56.4%. Clinical remission and MH rates after second GMA did not differ from those after first GMA in the same patients (week 6: clinical remission, 100% vs 88.4%, p = 0.134; MH, 100% vs 84.8%, p = 0.074). In conclusion, MH induction by intensive GMA without use of CS in ulcerative colitis patients contributes to subsequent longterm clinical remission maintenance. GMA re-treatment efficacy was comparable to that of first GMA in the same patients who had relapse.

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

“…The issue has been previously discussed. However, a number of non‐blinded trials, and post‐marketing surveys carried out in large series of patients, suggest that clinical, endoscopic, and histologic improvement, mucosal healing included, are comparable to that of steroids, immunomodulators and biologics 2,17,62,71 . Short duration of disease and steroid naïve condition, as expected, are the best predictors of response to AC 19,57,72 .…”

“…In some centers, a single‐needle, single‐catheter technique, involving the use of a pump equipped with a valve controlling the direction of blood flow has been used 16 . The procedure is usually performed on a weekly basis, but more aggressive, twice‐a‐week strategies have been proposed to foster efficacy 17,18 …”

“…Several open/ retrospective studies documented the efficacy of AC in improving clinical scores and endoscopic findings in UC, with response rates ranging from 60% to 80% (Table 1). 17,30‐35 Data were summarized in a large metanalysis reporting data from 594 patients, from seven trials 2 …”

“…GMA was used in alternative to corticosteroids in a series of patients with mild‐to‐moderate UC, leading to clinical improvement in 58.2% 37 . Moreover, intensive, twice‐a‐week GMA, proved more effective than the standard once‐a‐week schedule, in inducing mucosal healing and long‐term maintenance of remission in the absence of steroids 17 . Reducing the interval between sessions worked again in case of relapse 18 .…”