Keiji Matsuda 1 2, Kohei Ohno 1, Yuka Okada 1, Takahiro Yagi 1, Mitsuo Tsukamoto 1, Yoshihisa Fukushima 1, Atsushi Horiuchi 1, Ryu Shimada 1 2, Tsuyoshi Ozawa 1 2, Tamuro Hayama 1 2, Takeshi Tsuchiya 1 2, Junko Tamura 1, Hisae Iinuma 1, Keijiro Nozawa 1 2, Hitoshi Aoyagi 2 3, Akari Isono 2 3, Koichiro Abe 2 3, Shinya Kodashima 2 3, Takatsugu Yamamoto 2 3, Yoshitaka Kawasaki 4, Yoshifuru Tamura 4, Yuko Sasajima 5, Fukuo Kondo 5, Yojiro Hashiguchi 1 2 , Inflamm Intest Dis, 2020 Feb;5(1):36-41.
Adsorptive Granulocyte and Monocyte Apheresis Is Effective in Ulcerative Colitis Patients Both with and without Concomitant Prednisolone
The effect of GMA with concomitant PSL (Prednisolone) and that of GMA without PSL were not different, and GMA was effective irrespective of PSL administration. The present study showed that GMA had efficacy and led many UC patients treated by PSL to be steroid free with no safety concern in the real world, although there is the possibility of recruitment bias due to the retrospective nature of the study.
Addition of granulocyte/monocyte apheresis to oral prednisone for steroid-dependent ulcerative colitis: A randomized, multicentre, clinical trial.
Eugeni Domènech 1, Julián Panés 2, Joaquín Hinojosa 3, Vito Annese 4, Fernando Magro 5, Giacomo Carlo Sturniolo 6, Fabrizio Bossa 7, Francisco Fernández 8, Benito González-Conde 9, Valle García-Sánchez 10, Axel Dignass 11, José Manuel Herrera 12, José Luis Cabriada 13, Jordi Guardiola 14, Maurizio Vecchi 15, Francisco Portela 16, Daniel Ginard 17, J Crohns Colitis. 2018 May 25;12(6):687-694.
In a randomized trial, the addition of 7 weekly sessions of GMA to a conventional course of oral prednisone did not increase the proportion of steroid-free remissions in patients with active steroid-dependent UC, though it delayed clinical relapse.
Efficacy and safety of granulocyte adsorption apheresis in elderly patients with ulcerative colitis.
Background: Elderly ulcerative colitis (UC) is increasing. Elderly UC differ from younger UC with respect to the course of their disease. Granulocyte adsorption apheresis (CAP) is often used to treat elderly UC. We retrospectively analyzed the cases of elderly UC who underwent CAP for remission induction therapy in a comparison with younger UC. Methods: 96 patients with UC underwent CAP. Patients who concurrently received tacrolimus, biological agents, or high-dose steroid therapy were excluded. The remaining 80 patients were evaluated. We divided them into an elderly group (aged ≥65 years) and a younger group, and then we compared the groups’ (1) clinical characteristics, (2) the efficacy and adverse effects of CAP, and (3) the complications of PSL. Results: The remission rate was 70.8% in the elderly group and 87.5% in the younger group. There were significant differences between the two groups with respect to the age at the onset of UC, the estimated glomerular filtration rate on admission, underlying diseases, and complications of PSL therapy. Adverse effects of CAP included headache, complications of blood reinfusion, heparin allergy, hypotension, and failure of blood removal. There were significant differences between the two groups with respect to the complications of PSL therapy (all P < .05). Conclusions: Although the elderly group had longer durations of UC, a higher prevalence of underlying diseases, and a higher frequency of adverse events due to PSL therapy, no serious adverse effects of CAP occurred in either group. Thus, CAP was safe and effective in both younger and elderly UC.
Efficacy, safety and cost analyses in ulcerative colitis patients undergoing granulocyte and monocyte adsorption or receiving prednisolone.
In appropriately selected patients, GMA has significant efficacy with no safety concern. The higher cost of GMA vs PSL should be compromised by good safety profile of this non-pharmacological treatment intervention.
A Case Report of Steroid and Immunosuppressant-resistant Pyoderma Gangrenosum Successfully Treated by Granulocytapheresis
Abstract: Granulocytapheresis (GCAP) therapy is a newly developed therapeutic modality for inflammatory bowel diseases such as ulcerative colitis and Crohn’s disease. Pyoderma gangrenosum (PG) is a chronic inflammatory skin disease characterized by the appearance of erythematous macules and plaques with pustules or nodules that rapidly progress to ragged, undermined multiple ulcers. We attempted GCAP therapy in a patient with PG resistant to prednisolone and various other immunosuppressants. GCAP therapy was initiated at three- to four-day intervals and a good response from all skin lesions, with eventual total epithelialization, was observed after 10 sessions of this therapy. Furthermore, circulating levels of inflammatory cytokines such as interleukin-8 (IL-8) and granulocyte colony stimulating factor (G-CSF) also decreased after the GCAP therapy. Our results suggest that GCAP is a safe and useful tool for the treatment of intractable PG, and that IL-8 and G-CSF are likely to be involved in the pathogenesis of PG.
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