How would Adacolumn® complement the effect of other drugs in the IBD treatment when used in combination? 

Dr. Daniel Ginard

Combination treatment with Adacolumn® and a biologic may possibly act in different ways. We use two therapies in combination and they can then act synergistically or each one on its own. Then what Adacolumn® does is adsorb leukocytes and activated granulocytes, and reduce cytokines. In other words, it reduces the patient’s inflammatory complex. And it can act adjuvantly or synergistically with the biologic.

But it is also likely that decreasing inflammatory activity can increase the effectiveness of the biologic. What we have seen in some articles is that in these patients, the amount of the drug available increases, possibly because the amount of drug can increase when the inflammatory load is reduced, and also probably because it could reduce anti-drug antibodies.

We still have a lot of doubts and there a lot of things we don’t know about how it works and it can probably act in both ways by improving the function of the biologic, and also by decreasing the patient’s inflammatory activity.

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

In recent years, we have more and more medical therapies that have been approved for the treatment of ulcerative colitis and this is good news, but we also have more and more questions using these therapies because we have patients responding very well with biological therapies, but we have also patients with partial response to these therapies, but also with a loss of response. So, we are facing new questions every day with these therapies, but in recent years we have also evidence supporting the possible use of a combination therapy between apheresis and the biological therapies and we have this positive evidence with Anti-TNF agents for example, but also with used Ustekinumab or Vedolizumab, they also approved biological therapies for UC and we have positive evidence with all of them. We still have more questions about the mechanism of action of this combination therapy but at this time we know that it is beneficial, but we still need to know how this mechanism works. This is still going on and we will have probably more responses in the near future, but we also know that this is safe and this is also a major concern in these scenarios. We know that there are no more frequent infections and there are not more adverse events related to the pharisees but also to the biological therapy, so this is also very good news. This is a new window open for our patients and new opportunities because we are seeing patients with different situations and this is a new one.

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.
• Rodríguez-Lago I, Benítez JM, Sempere L, Sáez-González E, Barreiro-de Acosta M, de Zárate JO, Cabriada JL. The combination of granulocyte-monocyte apheresis and vedolizumab: A new treatment option for ulcerative colitis? J Clin Apher. 2019 Dec;34(6):680-685.
• Tanida S, Ozeki K, Kanno Tet al.: Combination Therapy With Ustekinumab Plus Intensive Granulocyte and Monocyte Adsorptive Apheresis in Patients With Refractory Ulcerative Colitis. J Clin Med Res. 2021 Nov;13(10-11):510-514.
• 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.