Kazuo Kusugami 1, Kenji Ina, Takafumi Ando, Kenji Hibi, Yuji Nishio, Hidemi Goto, J Gastroenterol. 2004 Dec;39(12):1129-37.
Tag: ulcerative colitis
Evidencia científica
Immunomodulatory therapy for inflammatory bowel disease
Patients with inflammatory bowel disease (IBD) have intestinal and extraintestinal symptoms that can greatly impair their quality of life. They must rely on multiple medications with aminosalicylates, corticosteroids, and purine analogues to control these symptoms. Although decades of clinical experience in IBD management has led to optimized approaches for achieving the induction and maintenance of remission, the disease in some patients is still refractory to conventional medical treatment, or the effectiveness of these drugs can be limited by treatment-related side effects. Significant progress in our understanding of the pathogenesis of IBD has yielded several immunomodulatory approaches with novel biological agents or apparatus, such as cyclosporine, cytoprotective agents, infliximab, and leukocytapheresis. Further immunomodulatoy therapy, aiming at the inhibition of molecular and cellular mediators, is anticipated, in parallel with the clarification of immunoinflammatory pathways in IBD. An additional goal will be to identify factors predictive of response to treatment with each novel immunomodulatory agent or apparatus. This will help provide each patient with optimized and individualized therapy, thereby increasing therapeutic efficacy and reducing possible side effects.
Evidencia científica
Granulocytapheresis is useful as an alternative therapy in patients with steroid-refractory or -dependent ulcerative colitis
Evidencia científica
Selective granulocyte and monocyte adsorptive apheresis as a first-line treatment for steroid naïve patients with active ulcerative colitis: a prospective uncontrolled study
Corticosteroid therapy of ulcerative colitis (UC) is associated with frequent adverse side effects and poor quality of life. Recently, adsorptive granulocyte and monocyte/macrophage apheresis has shown efficacy in patients with severe steroid refractory UC. The objective of this study was to investigate if, instead of corticosteroids, adsorptive leukocytapheresis has efficacy as the first-line therapy for steroid-naïve patients with active UC. Twenty patients, aged 15-49 years, with a mean clinical activity index (CAI) of 8.6 were recruited. Adsorptive leukocytapheresis was done with Adacolumn, which contains cellulose acetate beads as adsorptive carriers for granulocytes and monocytes (FcgammaR and complement receptors expressing leukocytes). Each patient received 6 to 10 leukocytapheresis sessions of 60-min duration, at 2 sessions/week. Efficacy was assessed 1 week after the last session. Post treatment, the mean CAI was 3.0 (P = 0001), and 17 of 20 patients (85%) were in remission. There were significant falls in C-reactive protein (P = 0.0003), total white cell counts (P = 0.003), neutrophils (P = 0.0029), and monocytes (P = 0.0038), an increase in lymphocytes (P = 0.001), and increases in the blood levels of soluble TNF-alpha receptors I (P = 0.0007) and II (P = 0.0045) in the column outflow (blood return to the patients). Further, at 8 months, 60% of patients had maintained their remission. No severe side effects were reported. In conclusion, adsorptive leukocytapheresis should reduce corticosteroid therapy in patients with moderate UC; cases with early-stage active disease may benefit most.
Evidencia científica
Leukocytapheresis for treatment of IBD
Yutaka Kohgo 1, Toshifumi Ashida, Atsuo Maemoto, Tokiyoshi Ayabe, J Gastroenterol. 2003 Mar;38 Suppl 15:51-4.
The recent development of effective and safe devices to remove leukocytes selectively from circulating blood has facilitated the application of leukocytapheresis for the treatment of inflammatory bowel disease (IBD). Successful results of preliminary trials of leukocytapheresis for IBD led to several nationwide multicenter clinical trials in Japan. As a result, five or six consecutive leukocytaphereses, which were undergone weekly, improved both symptoms and endoscopic findings in approximately 60%-80% of patients with ulcerative colitis (UC). In Japan, leukocytapheresis is now considered to be one of the standard treatments for UC patients with refractory disease to avoid surgery. Here, the current status of indications and mechanisms of action on UC are analyzed by reviewing the results of Japanese multicicenter trials, and the possible application for Crohn’s disease is also discussed.
Evidencia científica
Leukocyte adsorptive apheresis for the treatment of active ulcerative colitis: A prospective, uncontrolled, pilot study
Hiroyuki Hanai 1, Fumitoshi Watanabe, Ken Takeuchi, Takayuki Iida, Masami Yamada, Yasushi Iwaoka, Abby Saniabadi, Isao Matsushita, Yoshihiko Sato, Kotaro Tozawa, Hajime Arai, Takahisa Furuta, Ken Sugimoto, Ingvar Bjarnason, Clin Gastroenterol Hepatol. 2003 Jan;1(1):28-35.
The outcome of this study suggests that reduction of circulating granulocytes and monocytes results in alleviation of inflammation and promotes clinical remission in patients with severe active UC that has not responded to intensive corticosteroid treatment. These data suggest that formal controlled studies are warranted.
Evidencia científica
Oxidative Stress During Leukocyte Absorption Apheresis
Aki Hirayama 1, Sohji Nagase, Atsushi Ueda, Takashi Ishizu, Yoshinori Taru, Keigyou Yoh, Kouichi Hirayama, Masaki Kobayashi, Akio Koyama, J Clin Apher. 2003;18(2):61-6.
These results indicate that though the plasma antioxidant activity was diminished by a column passage, plasma antioxidant activity recovers during the procedure. This efficient antioxidative effect is limited to the early phase of the therapeutic course.
Evidencia científica
A new treatment for HCV-ulcerative colitis comorbidity intolerant to INF-α
Koji Sawada, Kunio Ohnishi, Ken Fukunaga, Takashi Shimoyama, Am J Gastroenterol. 2003 Jan;98(1):228-9.
Evidencia científica
Leukocytapheresis as an adjunct to conventional medication for inflammatory bowel disease.
Koji Sawada, Dis Colon Rectum. 2003 Oct;46(10 Suppl):S66-77.
Clinical data suggest that leukocytapheresis might be an effective adjunct to therapy for inflammatory bowel disease to promote remission, taper conventional drug dosage, and potentially reduce the number of patients who require colectomy. The results should further understanding of the pathophysiology of inflammatory bowel disease.
Evidencia científica
Granulocyte adsorptive apheresis for pediatric patients with ulcerative colitis
Takeshi Tomomasa 1, Akio Kobayashi, Hiroaki Kaneko, Sasaki Mika, Shun-Ichi Maisawa, Yoshie Chino, Hohkibara Syou, Atsushi Yoden, Jyunko Fujino, Makoto Tanikawa, Takafumi Yamashita, Shigeru Kimura, Maiko Kanoh, Koji Sawada, Akihiro Morikawa
Granulocytapheresis (GCAP) has produced efficacy in adult patients with ulcerative colitis (UC) by adsorbing activated granulocytes and monocytes/macrophages. We retrospectively investigated efficacy and safety of GCAP in pediatric patients with active UC. Twelve steroid-refractory children (12.2 +/- 3.1 years old) were treated with GCAP, one session/week for 5-10 consecutive weeks. In 8 patients, clinical symptoms improved after two GCAP sessions. Normal body temperature, stool frequency, and disappearance of blood in stool were seen after 24.3 +/- 11.5 days. The endoscopic grade improved from 2.6 +/- 0.3 to 0.4 +/- 0.2. One patient who initially responded, developed bloody diarrhea later and 2 cases remained unchanged. The dose of steroid was tapered during GCAP therapy by 50%. No serious adverse effects were noted. Four of 8 cases relapsed 3.5 +/- 2.2 months after the last GCAP while on maintenance therapy, the other 4 were in remission up to 22.8 +/- 18.1 months. In conclusion, GCAP appears to be effective and well tolerated in children with steroid-refractory UC.
Evidencia científica
The present status and the recent development of the treatment for inflammatory bowel diseases: desirable effect of extracorporeal immunomodulation
Masakazu Takazoe 1, Torao Tanaka, Kenji Kondo, Toshiki Ichimori, Toshio Shinoda Ther Apher 2002 Aug;6(4):305-11. doi: 10.1046/j.1526-0968.2002.00445.x.
The immunological and genetic pathogeneses of inflammatory bowel disease (IBD) have been well elucidated in the recent years. The pharmacologic treatment of IBDs accordingly becomes to focus upon the individual pathologic step (targeting therapy), whereas the therapeutic action is not yet a pinpoint one. It has been known recently that new drugs such as biological immunomodulating agents and anti-inflammatory cytokines have better short-term effects in some respects than the conventional drugs, and they might alter the treatment strategy of IBDs in the near future. The limitation of pharmacologic treatments mainly results from adverse effects of the drugs, i.e. infection susceptibility, oncogenesis, teratogenesis and so forth. The extracorporeal therapy such as leukocytapheresis and photopheresis is reportedly effective for IBDs probably through immunomodulation such as decrease in circulating activated T-lymphocytes and activated granulocytes that play a central role in the pathogenesis of IBD. It can be said that these extracorporeal treatment methods have advantage of rapid action and lack of serious adverse effects to drug therapy.
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