Section scientifique

Granulocyte and monocyte adsorption apheresis for paradoxical reaction to infliximab.

Section scientifique

Successful treatment of neutrophilic dermatosis in patient with Crohn’s disease with granulocyte and monocyte adsorption apheresis.

Section scientifique

Case of generalized pustular psoriasis with end-stage renal disease successfully treated with granulocyte monocyte apheresis in combination with hemodialysis.

Tomotaka Mabuchi 1Yasuaki ManabeHanako YamaokaTami OtaMasayuki KatoNorihiro IkomaYoshiyuki KusakabeHirotaka KomabaAkira Ozawa, J Dermatol. 2014 Jun;41(6):521-4.

 During maintenance HD twice a week, weekly GMA was started at Tokai University Hospital. The skin symptoms disappeared after five administrations of GMA. We suggest that GMA is an effective therapy for GPP patients with ESRD who are treated with HD.

https://pubmed.ncbi.nlm.nih.gov/24815562/

Section scientifique

Ulcerative colitis-associated pulmonary nodules with cavity formation successfully treated with mesalazine and granulocyte-monocyte apheresis.

Hiroaki Nomoto 1Yoshikazu HayashiSatoshi ShinozakiTomonori YanoKeijiro SunadaWataru SasaoAya KitamuraMai OhashiShuhei HiyamaAlan Kawarai LeforHironori Yamamoto, Clin J Gastroenterol 2014 Dec;7(6):476-80.

UC-associated pulmonary lesions can be treated without steroid administration, and we suggest that this strategy is an option for a patient with UC-associated pulmonary lesions that cannot be differentiated from an infection.

https://pubmed.ncbi.nlm.nih.gov/25491905/

Section scientifique

Efficacy and safety of granulocyte and monocyte adsorption apheresis for ulcerative colitis: A meta-analysis.

Takuya Yoshino 1Hiroshi Nakase 2Naoki Minami 3Satoshi Yamada 3Minoru Matsuura 3Shujiro Yazumi 4Tsutomu Chiba 3 , Dig Liver Dis. 2014 Mar;46(3):219-26.

Our meta-analysis reveals that intensive granulocyte and monocyte adsorption apheresis is a safe and effective treatment with higher rates of clinical remission and response for ulcerative colitis compared with corticosteroids.

https://pubmed.ncbi.nlm.nih.gov/24268950/

Section scientifique

Flare up of ulcerative colitis during pregnancy treated by adsorptive granulocyte and monocyte apheresis: therapeutic outcomes in three pregnant patients.

Hiroki Takahashi 1Kaori SugawaraMikako SugimuraMasahiro IwabuchiYutaka ManoKatsuaki UkaiKeiichi Tadokoro, Arch Gynecol Obstet. 2013 Aug;288(2):341-7.

In these three cases with active ulcerative colitis during pregnancy, granulocytapheresis as a non-pharmacologic treatment was effective and safe. In case 3 that did not respond well to the initial granulocytapheresis sessions, a moderate dose of prednisolone enhanced the efficacy of granulocytapheresis and tapering of prednisolone shortly after administration was not associated with relapse.

https://pubmed.ncbi.nlm.nih.gov/23404436/

Section scientifique

Current status and future perspectives of leukocytapheresis for inflammatory bowel disease.

Ken Fukunaga 1Takayuki Matsumoto, J Gastroenterol Hepatol. 2012 Jun;27(6):997-1003.

Ulcerative colitis (UC) and Crohn’s disease (CD) comprise the idiopathic inflammatory bowel diseases (IBD) of the gut. The etiology of IBD is poorly understood, but an autoimmune disturbance has been suggested to play an important role in this incurable disease. Extracorporeal leukocytapheresis (CAP) is an additional adjunct for IBD patients refractory to other conventional therapies, including steroids. The primary aim of CAP should be to suppress such unwanted immunological response by removing circulating inflammatory cells from the blood stream. The first decade has been passed since CAP was approved by Japanese social health insurance policy. It is therefore now an appropriate opportunity to upgrade and summarize our current understandings and/or future perspectives of this unique non-pharmacological and non-surgical strategy for IBD patients. According to several clinical and basic research reports, an early introduction of CAP should produce higher efficacy as compared with CAP applied sometime after a clinical relapse. Likewise, CAP therapy adjusted to patients’ body-weight as well as two treatment sessions per week (intensive regimen) should benefit the efficacy rate. The etiology of IBD is not fully elucidated yet. As a result, the major therapeutic strategies in the Western world have been immunosuppressive therapy, including biologics. CAP is an unusual treatment modality for IBD because it seems to have both effectiveness and safety, which should generally be balanced in this type of illness. We now have to develop future strategies with and without combining biologics to improve the quality of life of IBD patients.

https://pubmed.ncbi.nlm.nih.gov/22414250/

Section scientifique

Intermittent granulocyte and monocyte apheresis versus mercaptopurine for maintaining remission of ulcerative colitis: a pilot study.

Atsushi Sakuraba 1Toshiro SatoYuichi MorohoshiKatsuyoshi MatsuokaSusumu OkamotoNagamu InoueHiromasa TakaishiHaruhiko OgataYasushi IwaoToshifumi 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.

https://pubmed.ncbi.nlm.nih.gov/22607563/

Section scientifique

Mode of Action of Apheresis for IBD: Recent Findings—GCAP: GMA (Granulocyte and Monocyte Adsorptive Apheresis)

Nobuhito Kashiwagi

Japanese Journal of Apheresis 30(1): 39-47, 2011

Section scientifique

Selective depletion of peripheral granulocyte/monocyte enhances the efficacy of scheduled maintenance infliximab in Crohn’s disease

Ken Fukunaga,Yoko Yokoyama,Koji Kamikozuru,Koji Yoshida,Risa Kikuyama,Kazuko Nagase,Shiro Nakamura,Yoshiyuki Takei,Hiroto Miwa,Takayuki Matsumoto

J. Clin. Apheresis, 2010;25(4):226-8. doi: 10.1002/jca.20242.

Background: This is the first report on a case of Crohn’s disease (CD), who was successfully maintained with a combination of infliximab (IFX) and selective depletion of granulocytes/monocytes by adsorption (GMA). Case: A 33-year-old female with CD activity index (CDAI) 294.2 responded to iv IFX (5mg/kg) administered at weeks 0, 2, and 6 in combination with 3000 mg/day oral 5-aminosalicylic acid (5-ASA; CDAI = 118). Then IFX at 8 week intervals was given as maintenance therapy. Two weeks before the 5th scheduled IFX, the patient worsened with an increase in stool frequency and a rise in CDAI. GMA was administered at weeks 5, 6, and 7 after her 6th iv IFX. Her CDAI decreased from 166.2 to 126.3 and 111.9 before 2nd and 3rd GMA sessions. She received her 7th iv IFX while the CDAI was 83.6. GMA course was repeated before 8th and 9th IFX. The patient remained in stable clinical and endoscopic remission without experiencing any serious side effect. After achieving mucosal healing, the patient decided to cease IFX therapy while continuing with GMA. Conclusions: IFX appears to induce and maintain remission of CD, but it may lose its efficacy after repeated administration. GMA is safe and by selectively depleting elevated/activated leukocytes may be a useful adjunct for IFX efficacy.

https://pubmed.ncbi.nlm.nih.gov/20544712/

https://onlinelibrary.wiley.com/doi/10.1002/jca.20242

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