What is the most widely accepted or currently used maintenance regimen with Adacolumn®? 

Dra. Pilar Nós

It’s true that the treatment maintenance regimen with Adacolumn® has been subject of a lot of controversy. There is no clinical trial that supports any usage regimen. Classically, maintenance treatment regimens of one session per month have been used, sometimes two sessions per month when the situation was more complex. And something that was published recently is using treatment cycles. We take the classic approach, ten sessions with two sessions per week for the first two weeks and then one session per week. And then the patient may not need any more treatment. If the patient needs it and we do a second cycle of treatment, or even a third or fourth, the response continues to be very good, as was published recently. So, we can use it episodically. It is so acceptable because there are no studies or evidence comparing this episodic form with the standard form of monthly maintenance treatment.

• Adacolumn® instructions for use.
• Cabriada, J.L., Rodríguez-Lago, I. Granulocitoaféresis en 2017. Puesta al día. Enfermedad Inflamatoria Intestinal 2017 (16) 2, 62-69.
• Naganuma M et al. CAPTAIN study Group. Efficacy of apheresis as maintenance therapy for patients with ulcerative colitis in an open-label prospective multicenter randomised controlled trial. J Gastroenterol. 2020 Apr;55(4):390-400.
• K. Fugunaga, Y. Yokoyama, K.  Kamakoyuru, K. Nagase.  Adsorptive Granulocyte/Monocyte Apheresis for the Maintenance of Remission in Patients with Ulcerative Colitis: A Prospective Randomized, Double Blind, Sham-Controlled Clinical Trial, Gut and Liver 2012 6(4):427-33. Long-term follow-up wit.
• A. Lindberg, M. Eberhardson, M. Karlsson, P. Karlén Granulocyte and Monocyte Apheresis re-treatment in patients with chronically active inflammatory bowel disease., BMC Gastroenterol. 2010 Jul 6;10:73.
• 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.

Dr. Daniel Ginard

If we have to make a maintenance schedule in patients in whom we consider a maintenance treatment, the most common regimen is 1 session a month for the duration of the maintenance treatment, which could be months or it could be ongoing. The most widely accepted regimen would be 1 session a month.

• Naganuma M et al. CAPTAIN study Group. Efficacy of apheresis as maintenance therapy for patients with ulcerative colitis in an open-label prospective multicenter randomised controlled trial. J Gastroenterol. 2020 Apr;55(4):390-400.

Dra. Natalia Borruel

The most common maintenance regimen is one treatment session per month. After the induction regimen, it can also be done progressively with a weekly, fortnightly or monthly maintenance session. The patient’s evolution will tell us and we can adapt to the patient’s situation.

• K. Fugunaga, Y. Yokoyama, K.  Kamakoyuru, K. Nagase.  Adsorptive Granulocyte/Monocyte Apheresis for the Maintenance of Remission in Patients with Ulcerative Colitis: A Prospective Randomized, Double Blind, Sham-Controlled Clinical Trial, Gut and Liver 2012 6(4):427-33.
• 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.
• Naganuma M et al; CAPTAIN study Group. Efficacy of apheresis as maintenance therapy for patients with ulcerative colitis in an open-label prospective multicenter randomised controlled trial. J Gastroenterol. 2020 Apr;55(4):390-400.

Dr. Iago Rodríguez Lago

In some cases, after the induction therapy with apheresis, we consider also a maintenance therapy and this means that, well, if the patient has responded to the initial apheresis sessions, we can apply between one to two apheresis sessions per month so we can keep the patient on this therapy. But it is also very relevant to say that we can also combine this therapy with other medical therapies. So, in our practice, we apply two sessions per month, but according to the patient characteristics, the history of the patient with the disease, with previous medical therapies, we modify and adjust this frequency. So at least we usually recommend to use it for at least six months, and therefore, at this time we reconsider how the patient is responding according to the clinical parameters or the biomarkers. But in some cases, we even decide to continue on one or two sessions per month. It can last even for years that we have some cases with very nice experience.

• Instructions for use of Adacolumn®.
• Cabriada, J.L., Rodríguez-Lago, I. Granulocitoaféresis en 2017. Puesta al día. Enfermedad Inflamatoria Intestinal 2017 (16) 2, 62-69.
• Naganuma M et al. CAPTAIN study Group. Efficacy of apheresis as maintenance therapy for patients with ulcerative colitis in an open-label prospective multicenter randomised controlled trial. J Gastroenterol. 2020 Apr;55(4):390-400.
• 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.