Apheresis has some significant differences between the mechanism of action, the set of action and many other experience from the patient side also. So well, these are important difference when we are speaking about the main difference with apheresis, but probably the safety is one of the major difference between the apheresis and the other drugs. And I mean probably some patients are concerned about the safety of immunosuppressive or biological therapies but we are also of course concerned about the safety of these drugs. So, from one side or the other sometimes we prefer the apheresis because of the mechanism of action or the safety. So, depending on the conversation with the patient, the efficacy comes as the preferred option.
References:
- Cabriada JL, et al. Leukocytapheresis for steroid-dependent ulcerative colitis in clinical practice: results of a nationwide Spanish registry. J Gastroenterol. 2012 Apr;47(4):359-65.
- 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.
Dra. Pilar Nós
It’s true is that we have used it in severe, moderate-severe situations, in almost desperate situations, which aren’t common in clinical practice, and the effectiveness surprised us because we managed to avoid colectomy. We have published three cases of severe flare-ups and we managed to avoid colectomy in all three. It’s not a very common situation but I think that the combination with biologics, because it reduces the inflammatory load and improves the mechanism of action of the biologic, is a situation in which the effectiveness has surprised me. It was more expected or is more expected in steroid-dependency or in partial response, or in situation where you want to avoid immunosuppression, where initial Japanese studies report benefit rates between 40 and 60%, which are high. Above all, its effectiveness in situations with more moderate-severe flare-ups, even with hospitalised patients, has surprised me personally.
References:
- T. Yamamoto, T. Iida, K. Ikeya. A multicenter retrospective study aiming to identify patients who respond well to adsorptive granulomonocytapheresis in moderately to severely active ulcerative colitis. Clin Transl Gastroenterol 2018 Jul 6;9(7):170.
- 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. Daniel Ginard
I think I have already said that one of the main clinical benefits is safety. There are patients who don’t want to take certain types of treatment, for fear of side effects, and it is a therapy with a high safety profile.
One of the other benefits is that, as we have already said, there are some patients who have to go on to maintenance therapy, but the majority of patients, once they achieve a response, maintain their response despite stopping the treatment. In other words, the treatment achieves its objective, which is the patient’s remission, and this remission is maintained over time in a very high percentage of patients.
References:
- Hibi T, Sameshima Y, Sekiguchi Y, Hisatome Y et al.: Treating ulcerative colitis by Adacolumn therapeutic leucocytapheresis: clinical efficacy and safety based on surveillance of 656 patients in 53 centres in Japan Dig Liver Dis. 2009 Aug;41(8):570-7.
- Lindberg A, Eberhardson M, Karlsson M, Karlén P. Long-term follow-up with Granulocyte and Monocyte Apheresis re-treatment in patients with chronically active inflammatory bowel disease. BMC Gastroenterol. 2010 Jul 6;10:73.
- T Ljung, O Østergaard Thomsen, M Vatn, et al. :007Granulocyte, monocyte/macrophage apheresis for inflammatory bowel disease: The first 100 patients treated in Scandinavia, Scand. J. Gastroenterol. 42:2, 221-227.
Dra. Natalia Borruel
The clinical benefit of Adacolumn® with the biggest impact is, I think, essentially the safety profile of the technique. I think that, at this time when we have a big battery of biologics that we optimise with other drugs, with drug levels or with pharmacokinetics, what Adacolumn® provides is that extra effectiveness with a high safety profile. It is, perhaps, the strongest point of the technique.
References:
- Instrucciones de uso de Adacolumn®
- 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.
- Hibi T, Sameshima Y, Sekiguchi Y, Hisatome Y et al.: Treating ulcerative colitis by Adacolumn® therapeutic leucocytapheresis: clinical efficacy and safety based on surveillance of 656 patients in 53 centres in Japan Dig Liver Dis. 2009 Aug;41(8):570-7.
Dr. Eugeni Domènech
Beyond the clinical efficacy of GMA, there are two main aspects that I would like to highlight as a beneficial effect of GMA. First of all, in many prospective cohort or randomized control trials, it has been shown that those patients responding to GMA, they preserve the response. They maintain this response after a long time, even without repeating apheresis or even without adding any other therapy. So, it seems that those patients who initially benefit from the therapy, they maintain this benefit for a long time. And secondly, and this is maybe a more subjective effect or benefit of the therapy is the perception that patients have of the therapy itself. So, most patients responding to GMA, they don’t want to discontinue therapy because they have a good perception of therapy. Maybe because of its safety, but also because it’s convenient for the patient.
References:
- Instructions for use of Adacolumn®.
- 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.
- Sakuraba A et al. An open-label prospective randomized multicenter study shows very rapid remission of ulcerative colitis by intensive granulocyte and monocyte adsorptive apheresis as compared with routine weekly treatment. Am J Gastroenterol. 2009 Dec;104(12):2990-5. 19724269Hanai H et al. Leukocyte adsorptive apheresis for the treatment of active ulcerative colitis: a prospective, uncontrolled, pilot study. Clin Gastroenterol Hepatol. 2003 Jan;1(1):28-35.Hibi T, Sameshima Y, Sekiguchi Y, Hisatome Y et al.: Treating ulcerative colitis by Adacolumn® therapeutic leucocytapheresis: clinical efficacy and safety based on surveillance of 656 patients in 53 centres in Japan Dig Liver Dis. 2009 Aug;41(8):570-7.
- Vecchi M, Vernia P, Riegler G et al. Therapeutic landscape for ulcerative colitis: where is the Adacolumn® system and where should it be? Clin Exp Gastroenterol. 2013;6:1-7.
- Saniabadi AR, Hanai H, Takeuchi K, et al.: Adacolumn®, an adsorptive carrier based granulocyte and monocyte apheresis device for the treatment of inflammatory and refractory diseases associated with leukocytes. Ther Apher Dial. 2003;7:48–59.
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