Which regimen is currently the most widely accepted and used Adacolumn® induction regimen?

Dr. Daniel Ginard

The induction regimen for Adacolumn® treatment has classically involved 5 sessions of treatment, one a week, and this has been increasing over time. We have gradually realised that giving more sessions is more effective and we are increasing the number to between 7 and 10 sessions, which is the most widely accepted regimen. And, also, you can do one session per week or you can do 2 or even 3 in the initial weeks. And I think that the most widely accepted regimen currently would be 2 sessions in the first 3 weeks and then 1 session per week until you reach 10 sessions. And possibly, although there can be variations, I think that whether you choose 2 sessions in the initial weeks or only have 1 per week also depends on how severe the patient’s condition is, and on the situation and the venous accesses. But, probably, the most common regimen for patient induction is between 7 and 10 sessions.

• Adacolumn® Instructions for use.
• 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. 19724269.
• Yoko Yokoyama et al. A large-scale, prospective, observational study of leukocytapheresis for ulcerative colitis: Treatment outcomes of 847 patients in clinical practice, Journal of Crohn’s and Colitis, Volume 8, Issue 9, 1 September 2014, Pages 981–991.
• Hanai 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.
• Yoshino T et al. Efficacy and safety of granulocyte and monocyte adsorption apheresis for ulcerative colitis: a meta-analysis. Dig Liver Dis. 2014 Mar;46(3):219-26.
• PRODIGGEST CLINICAL PRACTICE PROTOCOLS: Rational use of granulocytopheresis in inflammatory bowel disease 2019.

Dra. Natalia Borruel

We usually use an intensive regimen in the first few weeks of treatment. And that is the most widely used regimen and it consists of doing at least ten sessions in the first five week, two sessions per week. This can be increased up to three sessions per week initially but this regimen of ten sessions in the first five weeks is fairly common. Some studies have compared it with conventional regimens in which there are fewer sessions or only one session per week and it has been observed, it has been demonstrated, that the response and remission rate is higher with these more intensive regimens. There are patients who may even need more sessions, but more sessions per week may be less tolerated by the patient because it involves more venipunctures. The maintenance can be adapted to the patient’s situation. You can then continue with one session per week for a few weeks and then do fortnightly or monthly maintenance regimens.

• 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. 19724269.
• 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. 

Dra. Pilar Nós

The induction regimen is most commonly used in situations where the patient is relatively stable, for example in a steroid dependency, which is one of the most widely accepted indications in ulcerative colitis, or a patient who is starting to lose a response to a different drug. Until recently it was one weekly session for 5-10 weeks. Today, I think we’ve gone beyond that and we are using more accelerated induction regimens. And it’s usual to have two sessions per week during the first two weeks and then, from the third or fourth week, if we see that the patient is tolerating it well, continue with one session per week until week ten. On some occasions, if the response is very favourable, we can settle for eight sessions, but the usual practice is to have two sessions a week for the first two weeks and then to get to the tenth session with one session a week.

• Adacolumn® instructions for use.
• Cabriada, J.L., Rodríguez-Lago, I. Granulocitoaféresis en 2017. Puesta al día. Enfermedad Inflamatoria Intestinal 2017 (16) 2, 62-69.
• 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. 19724269.