Long-term follow-up with Granulocyte and Monocyte Apheresis re-treatment in patients with chronically active inflammatory bowel disease

Lindberg, Annelie; Eberhardson, Michael; Karlsson, M.; Karlén, Per

doi:10.1186/1471-230x-10-73

Cited by 37 publications

(25 citation statements)

References 54 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The publication of the first clinical experience with GMA in patients with UC by Shimoyama, et al [31] generated significant interest in this non-pharmacological treatment intervention for patients with inflammatory diseases associated with activated myeloid lineage leucocytes [5-19,23-27,31-38]. However, as already mentioned, there is no shortage of contrasting efficacy outcome reports in the literature.…”

Section: Discussionmentioning

confidence: 99%

Looking for predictive factors of clinical response to adsorptive granulocyte and monocyte apheresis in patients with ulcerative colitis: markers of response to GMA

et al. 2013

View full text Add to dashboard Cite

BackgroundAdsorptive granulocyte and monocyte apheresis (GMA) with an Adacolumn in patients with ulcerative colitis (UC) has been applied as a non-pharmacological treatment strategy, but the efficacy has been encouraging as well as discouraging, depending on patients’ demography at entry. In this study, we looked for predictive factors for clinical response to GMA in patients with UC.MethodsIn a retrospective setting, 43 outpatients who had been treated with GMA for active UC were evaluated. Patients were divided into remission group and non-remission group based on Lichtiger’s clinical activity index (CAI) before and after 10, once a week GMA sessions. The efficacy was analysed in relation to patients’ demographic variables. To determine predictive factors that closely related to the response to GMA, receiver operating characteristic (ROC) curve, and multiple logistic regression analyses were applied.ResultsAfter 10 GMA sessions, the overall clinical remission rate (CAI < 4) was 53.5%. Multiple logistic regression and ROC analyses showed that the interval between relapse and the first GMA session was a significant and independent predictive factor for clinical response to GMA (P = 0.016); the clinical response was better in patients who received GMA immediately after a relapse and vice versa. Likewise, univariate analyses showed that, the duration of UC (P = 0.036) and the cumulative prednisolone (PSL) dose (P = 0.006) before the first GMA session were significantly greater in the GMA non-responder group as compared with the responder group. Additionally, a lower white blood cell (WBC) count at first GMA session was related to clinical response to GMA (P = 0.032).ConclusionsIn this study, patients with a short duration of UC and low cumulative PSL dose seemed to respond well to GMA. However, we found that the best responders were patients who received GMA immediately after a clinical relapse. Additionally, GMA was effective in patients with low WBC count at the first GMA session. The findings of this study should spare medical cost and reduce morbidity time for many patients, relevant for decision making in clinical settings.

show abstract

Section: Discussionmentioning

confidence: 99%

Looking for predictive factors of clinical response to adsorptive granulocyte and monocyte apheresis in patients with ulcerative colitis: markers of response to GMA

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Data show that granulocyte/ monocyte adsorption (GMA; Adacolumn, JIMRO, Takasaki, Japan) in patients with steroid-dependent or steroid-refractory IBD is associated with striking efficacy and tapering or discontinuation of steroids, whereas in steroid-naive patients, GMA spared patients from steroids (Hanai, 2008). It is an additional remission option for chronically active IBD patients (Lindberg et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

Inflammatory bowel disease unclassified

Zhou

Chen

et al. 2011

J. Zhejiang Univ. Sci. B

View full text Add to dashboard Cite

Abstract:Objective: Inflammatory bowel diseases (IBDs) are idiopathic, chronic, and inflammatory intestinal disorders. The two main types, ulcerative colitis (UC) and Crohn's disease (CD), sometimes mimic each other and are not readily distinguishable. The purpose of this study was to present a series of hospitalized cases, which could not initially be classified as a subtype of IBD, and to try to note roles of the terms indeterminate colitis (IC) and inflammatory bowel disease unclassified (IBDU) when such a dilemma arises. Methods: Medical records of 477 patients hospitalized due to IBD, during the period of January 2002 to April 2009, were retrospectively studied in the present paper. All available previous biopsies from endoscopies of these patients were reanalyzed. Results: Twenty-seven of 477 IBD patients (5.7%) had been initially diagnosed as having IBDU. Of them, 23 received colonoscopy and histological examinations in our hospital. A total of 90% (9/10) and 66.7% (4/6) of patients, respectively, had a positive finding via wireless capsule endoscopy (CE) and double-balloon enteroscopy (DBE). The barium-swallow or small bowel follow-through (SBFT) was performed on 11 patients. Positive changes were observed under computer tomographic (CT) scanning in 89.5% (17/19) of patients. Reasonable treatment strategies were employed for all patients. Conclusions: Our data indicate that IBDU accounts for 5.7% of initial diagnoses of IBD. The definition of IBDU is valuable in clinical practice. For those who had no clear clinical, endoscopic, histological, or other features affording a diagnosis of either UC or CD, IBDU could be used parenthetically.

show abstract

“…The sustainability of GMA induced remission is similar or better than conventional drugs. Patients who relapse respond well to another course of GMA . Regarding endoscopic remission rates in GMA treated cohorts, Tanaka, and colleagues reported an efficacy rate of 74% based on CAI and 61% based on EI in UC patients .…”

Section: Introductionmentioning

confidence: 99%

Granulomonocytapheresis as a cell‐dependent treatment option for patients with inflammatory bowel disease: Concepts and clinical features for better therapeutic outcomes

Saniabadi

Tanaka

Yamamoto

et al. 2018

J of Clinical Apheresis

View full text Add to dashboard Cite

Ulcerative colitis (UC) and Crohn's disease (CD) are major phenotypes of the chronic inflammatory bowel disease (IBD), which afflicts millions of individuals throughout the world with debilitating symptoms. The chronic nature of IBD means that patients require life‐long medications, and this may lead to drug dependency, loss of response together with adverse side effects as additional morbidity factors. The efficacy of antitumour necrosis factor (TNF)‐α biologics has validated the role of inflammatory cytokines notably TNF‐α in the exacerbation and perpetuation of IBD. However, cytokines are released by myeloid lineage leucocytes like the CD14+CD16+ monocyte phenotype. Additionally in IBD, myeloid leucocytes are elevated with activation behavior, while lymphocytes are compromised. Therefore, patients' leucocytes appear logical targets of therapy. Adsorptive granulomonocytapheresis (GMA) with an Adacolumn uses carriers, which interact with the Fcγ receptor expressing leucocytes and deplete the elevated myeloid leucocytes, while the neutrophils, which re‐enter the circulation via the Adacolumn outflow (≥40%) are phagocytosed by CD19 B‐cells to become interleukin (IL)‐10 producing Bregs or CD19highCD1Dhigh B‐cells. IL‐10 is an anti‐inflammatory cytokine. GMA has been applied to treat patients with IBD. The efficacy outcomes have been impressive as well as disappointing, the clinical response to GMA defines the patients' disease course and severity at entry. Efficacy outcomes in patients with deep ulcers together with extensive loss of the mucosal tissue are not encouraging, while patients without these features respond well and attain a favorable long‐term disease course. Accordingly, for responder patients, GMA fulfills a desire to be treated without drugs.

show abstract

Long-term follow-up with Granulocyte and Monocyte Apheresis re-treatment in patients with chronically active inflammatory bowel disease

Cited by 37 publications

References 54 publications

Looking for predictive factors of clinical response to adsorptive granulocyte and monocyte apheresis in patients with ulcerative colitis: markers of response to GMA

Looking for predictive factors of clinical response to adsorptive granulocyte and monocyte apheresis in patients with ulcerative colitis: markers of response to GMA

Inflammatory bowel disease unclassified

Granulomonocytapheresis as a cell‐dependent treatment option for patients with inflammatory bowel disease: Concepts and clinical features for better therapeutic outcomes

Contact Info

Product

Resources

About