Scientific corner

Addition of granulocyte/monocyte apheresis to oral prednisone for steroid-dependent ulcerative colitis: A randomized, multicentre, clinical trial.

Eugeni Domènech 1Julián Panés 2Joaquín Hinojosa 3Vito Annese 4Fernando Magro 5Giacomo Carlo Sturniolo 6Fabrizio Bossa 7Francisco Fernández 8Benito González-Conde 9Valle García-Sánchez 10Axel Dignass 11José Manuel Herrera 12José Luis Cabriada 13Jordi Guardiola 14Maurizio Vecchi 15Francisco Portela 16Daniel 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.

https://pubmed.ncbi.nlm.nih.gov/29490024/

Scientific corner

An open-label prospective randomized multicenter study of intensive versus weekly granulocyte and monocyte apheresis in active crohn’s disease.

Atsushi Sakuraba 1Satoshi MotoyaKenji WatanabeMasakazu NishishitaKazunari KankeToshiyuki MatsuiYasuo SuzukiTadayuki OshimaReiko KunisakiTakayuki MatsumotoHiroyuki HanaiKen FukunagaNaoki YoshimuraToshimi ChibaShinsuke FunakoshiNobuo AoyamaAkira AndohHiroshi NakaseYohei MizutaRyoichi SuzukiTaiji AkamatsuMasahiro IizukaToshifumi AshidaToshifumi Hibi, Am J Gastroenterol. 2009 Dec;104(12):2990-5.

Intensive GMA in patients with active UC seems to be more efficacious than weekly treatment, and significantly reduced the patients’ morbidity time without increasing the incidence of side effects.

https://pubmed.ncbi.nlm.nih.gov/19724269/

Scientific corner

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/

Scientific corner

Clinical Effectiveness of Selective Granulocyte, Monocyte Adsorptive Apheresis with the Adacolumn(®) Device in Ulcerative Colitis.

Brigitte Habermalz 1Stefan Sauerland, Dig Dis Sci. 2010 May;55(5):1421-8.

The purpose of this meta-analysis was to determine whether selective adsorptive granulocyte and monocyte apheresis (GMA apheresis) using the Adacolumn device can effectively reduce clinical symptoms and endoscopic signs of inflammation in patients with ulcerative colitis (UC). A comprehensive search for randomized controlled trials (RCTs) published up to May 2008 was performed. Each study’s quality was evaluated, and the data reported in the results were abstracted. Pooled relative risk (RR) estimates and 95% confidence intervals (CIs) were calculated using the fixed-effects model. Heterogeneity was quantified statistically and explained by the variation in the trial design. Seven RCTs including 594 patients were found, and six RCTs on active UC contributed to the main analyses. In half of the trials, GMA apheresis was compared to steroids. Only one trial was fully blinded. A response or remission after 6 weeks was achieved more often in patients treated with GMA apheresis (RR 1.42; CI 1.15-1.75). Also, after 12 weeks, GMA apheresis produced significantly higher remission rates (RR 1.41; CI 1.08-1.83), but long-term data were sparse. In the trials that compared GMA apheresis and steroids (n = 220 patients), side effects were much less frequent in the GMA apheresis groups (RR 0.19; CI 0.11-0.34). Homogeneous evidence from seven RCTs shows that GMA apheresis induces a clinical remission in a higher proportion of UC patients as compared to conventional medical therapy.

https://pubmed.ncbi.nlm.nih.gov/19517236/

Scientific corner

Systematic review: granulocyte/monocyte adsorptive apheresis for ulcerative colitis

S Thanaraj 1P J HamlinA C Ford,Aliment Pharmacol Ther . 2010 Dec;32(11-12):1297-306.

Granulocyte/monocyte adsorptive apheresis appears of some benefit in UC. High-quality RCTs comparing granulocyte/monocyte adsorptive apheresis with conventional medical therapy or sham procedure in Western populations, with disease activity confirmed endoscopically, are required.

https://pubmed.ncbi.nlm.nih.gov/21050231/

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