Effectiveness of granulocyte and monocyte adsorptive apheresis in patients with ulcerative colitis and 5-aminosalicylate intolerance

Masaki Kato ¹, Masaki Yamashita ¹, Shigeki Kojima ², Mitsuto Tsukui ¹, Yoshihiko Iijima ¹, Kenichi Araki ¹, Jun Ishida ¹, Takumi Komatsu ¹, Yusuke Nakamoto ¹, Akiyo Kawashima ¹, Maki Konno ¹, Hirofumi Kiyokawa ¹, Yoshinori Sato ¹, Tsutomu Sakurada ², Tadateru Maehata ¹, Hiroshi Yasuda ¹, Keisuke Tateishi ¹

Medicine (Baltimore). 2025 Aug 1;104(31):e43389. doi: 10.1097/MD.0000000000043389.

5-Aminosalicylate (5-ASA) intolerance complicates ulcerative colitis (UC) management, often necessitating alternative treatment approaches. Granulocyte and monocyte adsorptive apheresis (GMA) has been recognized as a safe treatment option for patients with UC who are refractory or intolerant to conventional drugs, including steroids; however, its effectiveness and safety in patients with 5-ASA intolerance remain unclear. This study aimed to investigate the effectiveness and safety of GMA in patients with UC and 5-ASA intolerance. We conducted a retrospective observational study to evaluate the effectiveness and safety of GMA in patients with UC and 5-ASA intolerance. Eighty-five patients with UC who underwent GMA were assessed, including 21 with 5-ASA intolerance and 64 with 5-ASA tolerance. This study compared the patient characteristics, treatment outcomes, concomitant drugs, and adverse events between the 2 groups. The remission rate was 28.6% (6/21) in the 5-ASA-intolerant group and 31.3% (20/64) in the 5-ASA-tolerant group, with no significant difference between the groups (P = .967). Both groups showed significant reductions in the dose of oral prednisolone and Lichtiger clinical activity index scores following the GMA. Our study suggests that GMA is equally effective and safe in 5-ASA-intolerant and 5-ASA-tolerant patients, offering an alternative treatment option in this challenging clinical scenario.