Scientific corner

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 1Satoshi TanidaTakashi MizushimaTsutomu MizoshitaHironobu TsukamotoYoshikazu HirataKenji MurakamiTakaya ShimuraHiromi KataokaTakeshi KamiyaTakashi 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.

Scientific corner

Adalimumab therapy following granulocyte and monocyte adsorptive apheresis in a patient with Crohn’s disease accompanied by chronic myeloid leukemia

Tsutomu Mizoshita 1Satoshi Tanida 2Shigeru Kusumoto 3Keiji Ozeki 2Hironobu Tsukamoto 2Masahide Ebi 2Yoshinori Mori 2Hiromi Kataoka 2Takeshi Kamiya 2Takashi 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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