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Can Adacolumn® be used in the maintenance treatment of a patient on induction treatment with a biologic who has a paradoxical/allergic reaction or loss of response to it at the end of the induction?
If I have a patient in whom I’ve used a biologic drug, and they have had a response or a partial response and have had an inflammatory reaction, an allergic reaction to the drug, an infusion reaction and I can’t keep using it, one alternative could be to use Adacolumn® to maintain or achieve complete remission in this patient and maintain remission. It could be an alternative to using any other drugs. Possibly, if it was a mild reaction, the patient may be able to try again with the drug and perhaps the adjuvant treatment may reduce the infusion reaction, but this is a practice for which we have little evidence at this time.
References:
- Yoko Yokoyama, Koji Sawada, Nobuo Aoyama, et al: Efficacy of Granulocyte and Monocyte Adsorptive Apheresis in Patients With Inflammatory Bowel Disease Showing Lost Response to Infliximab, Journal of Crohn’s and Colitis 2020,1-10.
- Rodríguez-Lago I, et al.: . Granulocyte-monocyte apheresis: an alternative combination therapy after Loss of response to anti-TNF agents in ulcerative colitis? Scand J Gastro 2019 Apr;54(4):459-464.
Dr. Iago Rodríguez Lago
We know that immunogenicity to Anti-TNF agents is the main driver to the loss of response and also to infusion reactions. This is one of the major concerns with Anti-TNF drugs. But we know at least there’s some preliminary evidence that has demonstrated that the combination between the apheresis and Infliximab therapy can reduce, can improve the situation of the Anti-TNF therapy by reducing the antidrug antibodies. This is very good evidence because this is one of the major drivers to the loss of response and the need for further changes on the therapy, so well, we need to still have further evidence, confirmation studies for this preliminary data.
But this is positive because it can to reduce one of the major problems with this therapy.
References:
- Yoko Yokoyama, Koji Sawada, Nobuo Aoyama, et al: Efficacy of Granulocyte and Monocyte Adsorptive Apheresis in Patients With Inflammatory Bowel Disease Showing Lost Response to Infliximab, Journal of Crohn’s and Colitis 2020,1-10.
- Rodríguez-Lago I, et al.: Granulocyte-monocyte apheresis: an alternative combination therapy after Loss of response to anti-TNF agents in ulcerative colitis? Scand J Gastro 2019 Apr;54(4):459-464.
- Iizuka M, Etou T, Sagara S. Efficacy of cytapheresis in patients with ulcerative colitis showing insufficient or lost response to biologic therapy. World J Gastroenterol. 2022 Sep 14;28(34):4959-4972.
- Bamias G, Zampeli E, Domènech E. Targeting neutrophils in inflammatory bowel disease: revisiting the role of adsorptive granulocyte and monocyte apheresis. Expert Rev Gastroenterol Hepatol. 2022 Aug;16(8):721-735.
- Domènech, E., et al Use of granulocyte/monocytapheresis in ulcerative colitis: A practical review from a European perspective. World journal of gastroenterology, 2021; 27(10), 908–918.
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