Ken Fukunaga 1, Yoko Yokoyama, Koji Kamokozuru, Kazuko Nagase, Shiro Nakamura, Hiroto Miwa, Takayuki Matsumoto, Gut Liver. 2012 Oct;6(4):427-33.
Tag : Clinical remission
Section scientifique
Adsorptive granulocyte/monocyte apheresis for the maintenance of remission in patients with ulcerative colitis: a prospective randomized, double blind, sham-controlled clinical trial.
Monthly GMA may potentially prevent UC relapse in patients who have achieved remission through weekly GMA, especially in patients on <20 mg/day PSL at the start of the maintenance therapy.
Section scientifique
Combination therapy with Adalimumab plus intensive granulocyte and monocyte adsorptive apheresis induced clinical remission in a Crohn’s disease patient with the loss of response to scheduled Adalimumab maintenance therapy: A case report
Keiji Ozeki 1, Satoshi Tanida, Takashi Mizushima, Tsutomu Mizoshita, Hironobu Tsukamoto, Yoshikazu Hirata, Kenji Murakami, Takaya Shimura, Hiromi Kataoka, Takeshi Kamiya, Takashi Joh, Intern Med. 2012;51(6):595-9.
A 21-year-old Caucasian man with a diagnosis of Crohn’s disease (CD) at the age of 14 was admitted to our hospital due to CD flare-up while under scheduled adalimumab (ADA) maintenance therapy. His symptoms remained virtually unchanged following high dose corticosteroid therapy. Seven days later, combination therapy with ADA plus intensive granulocyte/monocyte adsorptive apheresis (GMA) was initiated, which induced clinical remission. Therefore, combination therapy with ADA plus intensive GMA appears to be an effective therapeutic option for patients with severe CD while under scheduled ADA maintenance therapy.
Section scientifique
Successful treatment of three cases of generalized pustular psoriasis with granulocyte and monocyte adsorption apheresis.
Akiko Suzuki 1, Kunitaka Haruna, Yuki Mizuno, Yoshiyuki Kuwae, Yuka Ono, Kazuko Okumura, Osamu Negi, Yasuko Kon, Kaori Takeuchi, Kenji Takamori, Shigaku Ikeda, Yasushi Suga,Ther Apher Dial. 2012 Oct;16(5):445-8.
Generalized pustular psoriasis (GPP) is a rare form of psoriasis characterized by the presence of variable numbers of sterile pustules appearing in erythematous and scaly lesions, which are associated with moderate to severe constitutional symptoms. It can be life-threatening especially in the elderly; therefore, medical care must be performed in rapid succession of treatment especially in refractory cases. We have performed granulocyte and monocyte adsorption apheresis (GCAP) on three GPP cases associated with several systemic and laboratory findings. As a result, the edema, erythema and numbers of sterile pustules on the skin lesions were reduced dramatically in all three patients after the first sessions of GCAP therapy. The sizes of the psoriatic lesions were reduced in all three patients following a weekly GCAP treatment for 5 consecutive weeks. Psoriasis area and severity index on discharge had improved in all three patients. No serious adverse effects were observed for up to at least 8 months after treatment. We therefore considered GCAP as one effective alternative to currently existing therapies, especially for recalcitrant cases of GPP.
Section scientifique
Long-term clinical impact of early introduction of granulocyte and monocyte adsorptive apheresis in new onset, moderately active, extensive ulcerative colitis
Takayuki Yamamoto 1, Satoru Umegae, Koichi Matsumoto,J Crohns Colitis. 2012 Aug;6(7):750-5.
in patients with the first UC episode, GMA therapy at an early stage significantly reduces steroid administration and steroid-dependency in the long-term clinical course.
Section scientifique
Infliximab- and immunosuppressant-resistant Crohn’s disease successfully treated with adsorptive granulocyte apheresis combined with prednisolone.
Munenori Itagaki 1, Masayuki Saruta, Toshio Iinuma, Seiji Arihiro, Tomohiro Kato, Hisao Tajiri, Case Rep Gastroenterol. 2012 Jan;6(1):118-23.
Activated granulocytes, monocytes, and platelets appear to be closely involved in active Crohn’s disease (CD). Adsorptive granulocyte apheresis (GCAP) is a new treatment for inflammatory bowel disease. GCAP was used to treat a 23-year-old female patient with CD resistant to both infliximab (IFX) and azathioprine (AZA). At 16 years of age, the patient underwent a partial ileal resection for peritonitis caused by perforative ileitis. On pathological examination of the resected specimen, the diagnosis was CD. Mesalazine was started, but the patient did not comply with therapy. She was admitted to our hospital again in 2007 due to an acute exacerbation. IFX induction therapy was started. The combination of both AZA daily and IFX every 8 weeks was continued as maintenance therapy. However, she developed severe abdominal pain in September 2009. Computed tomography revealed ileitis and ascending colitis, and blood tests showed high inflammatory response marker levels. She was considered to have IFX- and AZA-resistant CD. Initial intravenous steroid therapy did not result in any improvement. Therefore, weekly GCAP therapy was given for 5 weeks, which immediately improved the inflammatory response markers. GCAP combined with prednisolone could be effective for IFX- and AZA-refractory CD.
Section scientifique
Intermittent granulocyte and monocyte apheresis versus mercaptopurine for maintaining remission of ulcerative colitis: a pilot study.
Atsushi Sakuraba 1, Toshiro Sato, Yuichi Morohoshi, Katsuyoshi Matsuoka, Susumu Okamoto, Nagamu Inoue, Hiromasa Takaishi, Haruhiko Ogata, Yasushi Iwao, Toshifumi Hibi,Ther Apher Dial. 2012 Jun;16(3):213-8.
The effect of granulocyte and monocyte adsorption apheresis (GMA) on prevention of relapse of ulcerative colitis (UC) is not clear. This was a pilot open-labeled, prospective, randomized, unblinded study to compare the tolerability and efficacy of intermittent GMA (once every 2 weeks) with mercaptopurine to maintain remission of UC. Twenty-one patients with UC, who had achieved remission by induction therapies were randomly assigned to receive either intermittent GMA (N = 10) or oral mercaptopurine (0.5 mg/kg per day; N = 11). The study period was 24 months. The rate of the patients maintaining remission and the incidences of adverse effects were compared between the two groups. At 24 months, seven of 10 patients (70.0%) on intermittent GMA and seven of 11 patients (63.6%, P = 1.00) on oral mercaptopurine were still in remission. Three patients relapsed in each group. One patient taking mercaptopurine, but none receiving intermittent GMA, dropped out because of adverse effects. Intermittent therapy with GMA was well tolerated and a substantial proportion of patients maintained remission. Intermittent GMA therapy in maintaining remission of UC merits further investigation.
Clinical remission / combination / Dermatology / Intermittent / maintenance / mercaptopurine / open-labeled / pilot study / prospective / randomized / Safety / unblinded /
Section scientifique
Granulocyte-monocyte apheresis for the treatment of inflammatory bowel disease.
Section scientifique
Predictors of clinical response in patients with ulcerative colitis treated with granulocyte-monocyte apheresis: analysis of the apheresis registry data.
Pietro Manuel Ferraro 1, Valeria D’Ovidio, Giampaolo Bresci, Marco Astegiano, Beatrice Principi, Renata D’Inca’, Roberto Testa, Daniela Valpiani, Luisa Guidi, Alessandro Armuzzi, Francesco Costa, Annalisa Aratari, Maurizio Vecchi, Roberto De Franchis, Vincenza Di Leo, Chiara Ricci, Gabriele Riegler, Elisabetta Colombo, Giuseppe Repaci, Pierenrico Lecis, Michele Silla, Stefano Passalacqua, G Ital Nefrol. Jan-Feb 2012;29 Suppl 54:S144-6.
We analyzed predictors of clinical response after a cycle of granulocytemonocyte apheresis in 173 patients with ulcerative colitis. Hemoglobin levels independently predicted good clinical outcome.
Section scientifique
Selective granulocyte and monocyte apheresis as a non-pharmacological option for patients with inflammatory bowel disease.
Gerda C Leitner 1, Nina Worel, Harald Vogelsang, Transfus Med Hemother. 2012 Aug;39(4):246-252.
Ulcerative colitis and Crohn’s disease are the two most prevalent inflammatory bowel diseases. In both cases, the medically refractory and steroid-dependent type presents a therapeutic challenge. To help resolve this problem, a mainly Japanese team developed a new therapeutic option. There are two systems, both of which are able to selectively remove the main mediators of the disease, namely the activated pro-inflammatory cytokine-producing granulocytes and monocytes/macrophages, from the patient’s blood circulation (GMA = granulocyte monocyte apheresis). One of the two systems is the Adacolumn( (®) ) (Immunoresearch Laboratories, Takasaki, Japan) consisting of the ADA-monitor and a single-use column, which contains approximately 35,000 cellulose acetate beads. The exact mode of action is not yet sufficiently understood, but however, a modulation of the immune system takes place. As a result, less pro-inflammatory cytokines are released. Furthermore, the production of anti-inflammatory interleukin-1 receptor antagonist is increased, and the apoptosis of granulocytes boosted. The decreased LECAM-1-expression on leukocytes impedes the leukotaxis to the inflamed tissue, and CD10-negative immature granulocytes appear in the peripheral blood. Another effect to be mentioned is the removal of the peripheral dendritic cells and the leachate of regulatory T cells (T-regs). The second system is the Cellsorba( (®) ) FX Filter (Asahi Medical, Tokyo, Japan). The range of efficiency, the indication, and the procedure are very similar to the Adacolumn. Solely the additional removal of lymphocytes can possibly limit the implementation since lymphopenia can increase the risk of autoimmune disease. Both systems provide a low-risk therapy with few adverse reactions. ASFA recommendations for GMA in inflammatory bowel disease are 2B due to the fact that not enough randomized double-blind studies are available to proof the efficacy of this treatment.
Adacolumn / apoptosis / ASFA / CD10- / Cellsorba / Clinical remission / DC / IL1R / immunological effects / LECAM-1(L-selectin) / non-pharmacological / Safety / steroid-dependent / Steroid-refractory / Tregs /
Section scientifique
Adalimumab therapy following granulocyte and monocyte adsorptive apheresis in a patient with Crohn’s disease accompanied by chronic myeloid leukemia
Tsutomu Mizoshita 1, Satoshi Tanida 2, Shigeru Kusumoto 3, Keiji Ozeki 2, Hironobu Tsukamoto 2, Masahide Ebi 2, Yoshinori Mori 2, Hiromi Kataoka 2, Takeshi Kamiya 2, Takashi Joh 2,Clin J Gastroenterol. 2012 Aug;5(4):302-6.
A 52-year-old woman was diagnosed with Crohn’s disease (CD) of the large intestine in May 2001. Her disease was accompanied by the development of chronic myelogenous leukemia (CML) in December 2003. Remission of her CML has been maintained up to the present with tyrosine kinase inhibitors. Clinical and endoscopic remission of the patient’s CD was maintained with salazosulfapyridine (3000 mg/day) and occasional prednisolone (≤20 mg/day) from 2001 to 2010. However, in December 2010 the patient complained of abdominal pain and diarrhea more than 10 times a day. Endoscopy showed serpiginous (snake-like) ulcers in the transverse colon and aphthous ulcers in the sigmoid colon. Intensive granulocyte and monocyte adsorptive apheresis (GMA) (two sessions per week, total of ten sessions) was performed, and the CD activity index (CDAI) decreased from 259 to 175. Six adalimumab injections were administered to improve the remaining inflammatory mucosa. Two months after induction therapy with adalimumab, the CDAI decreased from 175 to 107 without side effects. Endoscopy revealed mucosal healing of the colonic inflammatory lesions. We experienced a case of a patient with CD accompanied by CML. We successfully treated the patient by a combination of intensive GMA and adalimumab
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