The combination of granulocyte‐monocyte apheresis and vedolizumab: A new treatment option for ulcerative colitis?

Abstract

Objectives To assess the effectiveness and safety of combining granulocyte‐monocyte apheresis (GMA) and vedolizumab (VDZ) in patients with refractory ulcerative colitis (UC). Methods This retrospective, multicentre pilot study included all UC patients receiving both GMA and VDZ. We recorded data on GMA sessions, demographic characteristics, and clinical response. Effectiveness was assessed 1 and 6 months after finishing the GMA using the partial Mayo score, C‐reactive protein, and fecal calprotectin levels. Data were also compiled on VDZ intensification, use of new immunomodulators and colectomy during follow‐up. Results Eight patients were included (mean age 46 years; 63% female; mean disease duration, 132 months; 50% E3). GMA was started after a loss of response to VDZ in all cases (25% primary nonresponse and 75% secondary loss of response). All had previously received anti‐TNF agents. VDZ was prescribed as the second‐, third‐, or fourth‐line biologic in 37%, 50%, and 13% of cases, respectively. Patients had a mean baseline partial Mayo score of 7.5 (SD 2.1) and received a median of 15 GMA sessions (range 5‐38). After a median follow‐up of 7.5 months (IQR 5‐12), partial Mayo score decreased after 1 and 6 months (P = .01 and .06, respectively). Three patients (38%) achieved steroid‐free clinical remission and five (63%) withdrew VDZ. Colectomy rate was 38%. No adverse events were observed during the combination therapy. Conclusions This small case series suggests that combining GMA with VDZ could be a treatment option in selected cases of UC with an inadequate response to this biologic agent.

Pyoderma gangrenosum in an ulcerative colitis patient during treatment with vedolizumab responded favorably to adsorptive granulocyte and monocyte apheresis

“…In such a situation, combined treatment with GMA and VDZ has been attempted in patients with refractory UC and was reported to be effective. 23 Therefore, in this case who had experienced LOR to anti-TNFα, VED appeared to be effective for intestinal IBD lesions, but with the appearance of PG, we opted for prednisolone and GMA combination therapy. In particular, GMA has a very favorable safety profile, with adverse side effects being uncommon and never severe.…”

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 .…”

Granulocyte and monocyte/macrophage apheresis in paediatric patients with ulcerative colitis: a case series in Spain

“…In eight adult patients with UC, with primary or secondary loss of response to VDZ, and previously treated with anti-TNF agents, partial Mayo score improved after 1 and 6 months of combining GMA and VDZ. 34 In another adult patient with refractory UC and no response to VDZ, clinical remission was achieved with the combination of GMA and VDZ. 35 …”