Katsuyoshi Matsuoka 1, Taku Kobayashi 1, Fumiaki Ueno 2 3, Toshiyuki Matsui 1, Fumihito Hirai 1, Nagamu Inoue 1, Jun Kato 1, Kenji Kobayashi 1, Kiyonori Kobayashi 1, Kazutaka Koganei 1, Reiko Kunisaki 1, Satoshi Motoya 1, Masakazu Nagahori 1, Hiroshi Nakase 1, Fumio Omata 1, Masayuki Saruta 1, Toshiaki Watanabe 1, Toshiaki Tanaka 1, Takanori Kanai 1, Yoshinori Noguchi 1, Ken-Ichi Takahashi 1, Kenji Watanabe 1, Toshifumi Hibi 1, Yasuo Suzuki 1, Mamoru Watanabe 1, Kentaro Sugano 1, Tooru Shimosegawa 1 , J Gastroenterol. 2018 Mar;53(3):305-353.
Tag: Crohn's disease
Evidencia científica
Evidence-based clinical practice guidelines for inflammatory bowel disease
Inflammatory bowel disease (IBD) is a chronic disorder involving mainly the intestinal tract, but possibly other gastrointestinal and extraintestinal organs. Although etiology is still uncertain, recent knowledge in pathogenesis has accumulated, and novel diagnostic and therapeutic modalities have become available for clinical use. Therefore, the previous guidelines were urged to be updated. In 2016, the Japanese Society of Gastroenterology revised the previous versions of evidence-based clinical practice guidelines for ulcerative colitis (UC) and Crohn’s disease (CD) in Japanese. A total of 59 clinical questions for 9 categories (1. clinical features of IBD; 2. diagnosis; 3. general consideration in treatment; 4. therapeutic interventions for IBD; 5. treatment of UC; 6. treatment of CD; 7. extraintestinal complications; 8. cancer surveillance; 9. IBD in special situation) were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases. The guidelines were developed with the basic concept of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Recommendations were made using Delphi rounds. This English version was produced and edited based on the existing updated guidelines in Japanese.
Evidencia científica
Inflammatory bowel disease patients experiencing a loss of response to infliximab regain long-term response after undergoing granulocyte/monocyte apheresis: A case series.
Yoko Yokoyama 1, Koji Kamikozuru 2, Kenji Watanabe 2, Shiro Nakamura 2 , Cytokine. 2018 Mar;103:25-28.
To our best knowledge, this is the first report of adding a non-drug GMA to restore the efficacy of infliximab. The outcomes, albeit in three cases, are relevant in therapeutic settings and should inspire further studies in a larger number of patients.
Evidencia científica
Cytapheresis (CAP) with leukocyte removal filter/bead column as onetherapeutic option for inflammatory bowel disease
Koji Sawada 1 , Transfus Apher Sci. 2017 Oct;56(5):689-697.
Clinical studies with these two new models have shown good effects for active IBD. Clinical data suggest that leukocytapheresis might be an effective adjunct to therapy of IBD, to promote remission, taper conventional drug dosage and potentially should reduce the number of patients who require colectomy. The results may further understandings of the pathophysiology of IBD and this in turn should contribute to a more effective treatment of this disorder.
Evidencia científica
Treatment options for children and adolescents with Inflammatory Bowel Disease: Is granulomonocytapheresis an effective alternative to drug therapy?
Tomotaka Tanaka 1, Takayuki Yamamoto 2, Koji Sawada 3, Rodolfo Sacco 4 , Expert Rev Gastroenterol Hepatol. 2017 Aug;11(8):749-758.
Patients with inflammatory bowel diseases (IBD) require life-long medications, which even if effective have the potential to cause adverse effects as additional morbidity factors. In pediatric patients, drug therapy has more serious limitations, including impaired physical and mental development. A non-drug therapeutic option is believed to be depletion of elevated and activated granulocytes and monocytes known to release inflammatory cytokines, like the CD14+CD16+ monocyte phenotype known to release tumor necrosis factor-α. Areas covered: Granulomonocyteapheresis (GMA) with an Adacolumn as a treatment option for IBD patients has been applied for the past 15 years. This article reviews the argument that GMA is a relevant and effective non-pharmacologic intervention in pediatric IBD setting. Expert commentary: GMA with an Adacolumn has shown promise in adult, pediatric, and adolescent patients with active IBD. There is evidence of post-GMA immunomodulation in terms of increased regulatory T-cell and B-cell activities. Additionally, patients who respond to GMA may attain a favorable long-term clinical course by avoiding pharmacologicals during an early phase of their active IBD. GMA has a good safety profile, especially in difficult-to-treat and pediatric settings. An additional trial is warranted to assess the efficacy of GMA in the early phase of pediatric IBD to optimize patient selection.
Evidencia científica
Letter to Yokoyama et al. (Yokoyama Y. Cytokine. 2017 Dec 29; 103: 25–28)
Iago Rodríguez-Lago 1, José Luis Cabriada 2 , Cytokine. 2018 Apr;104:29.
Evidencia científica
Granulocitoaféresis en 2017. Puesta al día (Spanish)
Enfermedad Inflamatoria Intestinal 20017 (16) 2, 62-69 DOI: 10.1016/j.eii.2016.12.001
Granulocyte apheresis is a procedure that allows the removal of different activated leukocyte populations and it also modifies some circulating inflammatory mediators. These effects, along with its immunomodulatory potential, make it an attractive therapeutic option in inflammatory bowel disease. Previous studies with this technique have had significant limitations, but recent data is emerging about the ideal clinical setting in which granulocyte apheresis should be indicated. Most of the evidence supports its use in conditions that are dependent or refractory to corticosteroids, especially when treatments with immunomodulators or biologics has failed and when it is necessary to reduce or avoid the use of systemic corticosteroids. Its excellent safety profile gives it a role in cases of comorbidity or risk in the use of immunosuppressive drugs or in paediatric patients. In this review, we provide an update on the role of granulocyte apheresis in inflammatory bowel disease.
combination / comorbidity / Crohn's disease / gma / IBD / Leukocytapheresis / MOA / pediatric / Safety / steroid-dependent / Steroid-refractory / ulcerative colitis /
Evidencia científica
Guidelines on the Use of Therapeutic Apheresis in Clinical Practice-Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Seventh Special Issue.
Anand Padmanabhan 1, Laura Connelly-Smith 2, Nicole Aqui 3, Rasheed A Balogun 4, Reinhard Klingel 5, Erin Meyer 6, Huy P Pham 7, Jennifer Schneiderman 8, Volker Witt 9, Yanyun Wu 10, Nicole D Zantek 11, Nancy M Dunbar 12, Guest Editor Joseph Schwartz 13 , J Clin Apher. 2019 Jun;34(3):171-354.
The Eighth Edition comprises 84 fact sheets for relevant diseases and medical conditions, with 157 graded and categorized indications and/or TA modalities. The Eighth Edition of the JCA Special Issue seeks to continue to serve as a key resource that guides the utilization of TA in the treatment of human disease.
Evidencia científica
Pharmacological- and non-pharmacological therapeutic approaches in inflammatory bowel disease in adults.
Gerda C Leitner 1, Harald Vogelsang 1 , World J Gastrointest Pharmacol Ther. 2016 Feb 6;7(1):5-20.
As therapeutic alternative the main mediators of the disease, namely the activated pro-inflammatory cytokine producing leukocytes can be selectively removed via two apheresis systems (Adacolumn and Cellsorba) in steroid-refractory or dependent cases. Extracorporeal photopheresis results in an increase of regulatory B cells, regulatory CD8(+) T cells and T-regs Type 1. Both types of apheresis were able to induce clinical remission and mucosal healing accompanied by tapering of steroids.
Evidencia científica
Immunological Mechanisms of Adsorptive Cytapheresis in Inflammatory Bowel Disease.
Esteban Sáez-González 1, Inés Moret 2 3 4, Diego Alvarez-Sotomayor 2, Francia Carolina Díaz-Jaime 2, Elena Cerrillo 2 3, Marisa Iborra 2 3 4, Pilar Nos 2 3 4, Belén Beltrán 2 3 4 , Dig Dis Sci. 2017 Jun;62(6):1417-1425.
The benefit of cytapheresis appears to rest upon its ability to reduce levels of certain immune cell populations; however, whether this depletion results in further changes in lymphocyte populations and cytokine production needs further clarification. In this review, we aim to summarize existing evidence on the role of cytapheresis in patients with IBD, its effect on cytokine levels and cellular populations, and to discuss its potential impact on disease activity.
Evidencia científica
Retrospective Single Center Study of Granulocyte Monocyte Adsorption Apheresis Treatment in Inflammatory Bowel Disease.
Kajsa Edfors 1, Dagny Ståhlberg 1, Charlotte Söderman 1 , Ther Apher Dial. 2016 Feb;20(1):79-85.
Most frequently reported was headache (N = 4). GMA seems to be a valuable adjuvant treatment regime in the care of patients with refractory IBD.
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