Zhenfei Liu 1, Xueliang Jiang 2, Chengcheng Sun 3 , Eur J Intern Med. 2016 Dec;36:e26-e27.
Tag: Crohn's disease
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Letter: The efficacy and safety of selective granulocyte and monocyte apheresis for inflammatory bowel disease: A meta-analysis.
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Tu1987 A Longitudinal Study of FDG-PET in Crohn’s Disease Patients Receiving Granulocyte/Monocyte Apheresis Therapy
Yoshioka, Shinichiro; Mitsuyama, Keiichi; Kuwaki, Kotaro; Yamauchi, Ryosuke; Yamasaki, Hiroshi; Fukunaga, Shuhei; Takedatsu, Hidetoshi; Tsuruta, Osamu; Torimura, Takuji (2016). Tu1987 A Longitudinal Study of FDG-PET in Crohn’s Disease Patients Receiving Granulocyte/Monocyte Apheresis Therapy. Gastroenterology, 2016 150(4), S998–. doi:10.1016/s0016-5085(16)33380-7
Background: Endoscopy is the gold standard for the diagnosis and follow-up of patients with Crohn’s disease (CD). However, a less invasive approach is now being sought for the management of these patients. The objective of this study was to examine whether 18Ffluorodeoxyglucose (FDG)-positron emission tomography (PET) might be relevant for monitoring the disease activity in CD patients undergoing granulocyte/monocyte apheresis (GMA). Methods: This study was conducted in 12 patients with CD, who were receiving treatment with 10, once a week GMA sessions with the Adacolumn. The response to treatment was monitored by measuring the standard laboratory variables, the Crohn’s disease activity index (CDAI) score, the international organization for the study of inflammatory bowel diseases (IOIBD) score, and the regional and global bowel uptakes on FDG-PET. Results: In 6 of the 12 patients, significant improvement of the CDAI was observed after the final session of GMA. The patients who showed clinical response to GMA had a decrease in the regional and global bowel uptakes on FDG-PET, whereas those who did not respond showed no change. In the patients who responded to the GMA, the decrease in regional bowel uptake on FDG-PET in each disease area of the same patient varied in parallel. There was a significant correlation between decrease in the global bowel uptake on FDG-PET and improvement of
the CDAI and IOIBD scores. Conclusion: The longitudinal changes in FDG-PET uptakes are of potential clinical interest for assessing the regional and global bowel disease activity in CD patients undergoing GMA therapy.
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Current Treatment Options for Inflammatory Bowel Diseases and Future Perspectives
TARO OSADA＊, SUMIO WATANABE＊, Juntendo Medical Journal61 (6), 588-596
In recent years, landmark progress has been made in the treatment of patients with inflammatory bowel
diseases (IBD). The anti-tumour necrosis factor (TNF)-α antibody era has shown that mucosal healing is a key
therapeutic goal, and may predict the sustainability of remission or resection-free survival in IBD patients.
Further, the anti-TNF-α antibody infliximab (IFX) became an alternative medication for refractory UC in 2010
under the Japan national health reimbursement scheme. However, to induce remission in steroid-refractory UC,
currently several therapeutic options are available in Japan including cytapheresis, tacrolimus, and anti-TNF-α
biologics, but as yet, there are no guidelines for the sequence and timing of these therapeutic interventions.
Additionally, there are many patients who do not respond, or are intolerant, to anti-TNF-α biologics. Recently,
new strategies like faecal microbiota transplantation and anti-leucocyte infiltration have been tested for induction
and maintenance of remission in IBD patients. This paper provides an overview of the latest treatment options and
future perspectives in IBD therapy
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Treatment of Crohn’s disease and familial Mediterranean fever by leukopheresis: single shot for two targets.
Mahmut Yuksel, Fatih Saygili, Orhan Coskun, Nuretdin Suna, Mustafa Kaplan, Ufuk Baris Kuzu, Zeki Mesut Yalin Kilic, Yasemin Ozderin Ozin, Ertugrul Kayacetin, World J Gastroenterol 2015 April 7; 21(13): 4078-4081
Long term maintenance with GMA for both CD and FMF is not possible, but during remission of CD the patient would have a chance to initiate colchicine again which will be a definitive therapy for FMF. We have already known the beneficial effect of GMA in CD from the literature
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Granulocyte and monocyte adsorption apheresis for generalized pustular psoriasis: therapeutic outcomes in three refractory patients
Tomomi Fujisawa 1, Satoko Suzuki 1, Yoko Mizutani 1, Tomoaki Doi 2, Shozo Yoshida 2, Shinji Ogura 2, Mariko Seishima 1 , Ther Apher Dial. 2015 Aug;19(4):336-41.
GMA showed efficacy for the treatment of refractory GPP patients as a non-pharmacologic intervention without any associated adverse effects, and was particularly effective in the first course, but also effective in the subsequent courses.
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Treating Inflammatory Bowel Disease by Adsorptive Leucocytapheresis: A Desire to Treat without Drugs
Abbi R Saniabadi 1, Tomotaka Tanaka 1, Toshihide Ohmori 1, Koji Sawada 1, Takayuki Yamamoto 1, Hiroyuki Hanai World J gastroenterol. 2014 Aug 7;20(29):9699-715
Ulcerative colitis and Crohn’s disease are the major phenotypes of the idiopathic inflammatory bowel disease (IBD), which afflicts millions of individuals throughout the world with debilitating symptoms, impairing function and quality of life. Current medications are aimed at reducing the symptoms or suppressing exacerbations. However, patients require life-long medications, and this can lead to drug dependency, loss of response together with adverse side effects. Indeed, drug side effects become additional morbidity factor in many patients on long-term medications. Nonetheless, the efficacy of anti-tumour necrosis factors (TNF)-α biologics has validated the role of inflammatory cytokines notably TNF-α in the exacerbation of IBD. However, inflammatory cytokines are released by patients’ own cellular elements including myeloid lineage leucocytes, which in patients with IBD are elevated with activation behaviour and prolonged survival. Accordingly, these leucocytes appear logical targets of therapy and can be depleted by adsorptive granulocyte/monocyte apheresis (GMA) with an Adacolumn. Based on this background, recently GMA has been applied to treat patients with IBD in Japan and in the European Union countries. Efficacy rates have been impressive as well as disappointing. In fact the clinical response to GMA seems to define the patients’ disease course, response to medications, duration of active disease, and severity at entry. The best responders have been first episode cases (up to 100%) followed by steroid naïve and patients with a short duration of active disease prior to GMA. Patients with deep ulcers together with extensive loss of the mucosal tissue and cases with a long duration of IBD refractory to existing medications are not likely to benefit from GMA. It is clinically interesting that patients who respond to GMA have a good long-term disease course by avoiding drugs including corticosteroids in the early stage of their IBD. Additionally, GMA is very much favoured by patients for its good safety profile. GMA in 21st century reminds us of phlebotomy as a major medical practice at the time of Hippocrates. However, in patients with IBD, there is a scope for removing from the body the sources of pro-inflammatory cytokines and achieve disease remission. The bottom line is that by introducing GMA at an early stage following the onset of IBD or before patients develop extensive mucosal damage and become refractory to medications, many patients should respond to GMA and avoid pharmacologics. This should fulfill the desire to treat without drugs.
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First successful use of leukocyte apheresis as maintenance therapy for Crohn’s disease in the United Kingdom.
David Tate 1, Vida Cairnes, Roland Valori, Richard Makins, J Clin Apher. 2014 Jun;29(3):181-2
We describe the case of a 24 year old male with severe fistulating Crohn’s disease who failed mutliple modalities of medical and surgical therapy. We present objective and subjective evidence of disease remission after induction and maintenance treatment with leukocyte apheresis. This is the first described case of successful maintenance treatment of severe Crohn’s disease with leukocyte apheresis in the United Kingdom.
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Crohn’s disease complicated by hepatitis B virus successfully treated with the use of adsorptive depletion of myeloid lineage leucocytes to suppress inflammatory cytokine profile.
Yoko Yokoyama 1, Ken Fukunaga 2, Koji Kamikozuru 2, Toshiyuki Sato 2, Mikio Kawai 2, Koji Nogami 2, Kazuko Nagase 2, Misaki Nakamura 2, Masaki Immured 2, Nobuyuki Hida 2, Shiro Nakamura 2 , Cytotherapy. 2014 Jun;16(6):821-5.
Immunosuppressive therapy required to treat an active CD potentially can promote HBV reactivation and worsen liver function. In this study involving a CD case complicated by chronic HBV infection, intensive GMA as a non-pharmacologic treatment intervention was associated with clinical remission and endoscopic improvement without HBV reactivation. Furthermore, GMA was well-tolerated and was without any safety concern. However, suppression of tumor necrosis and interleukin-6by GMA in this clinical setting is potentially very interesting.
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Therapeutic landscape for ulcerative colitis: where is the Adacolumn(®) system and where should it be?
Maurizio Vecchi 1, Piero Vernia, Gabriele Riegler, Renata D’Incà, Vito Annese, Siro Bagnoli, Clin Exp Gastroenterol. 2013;6:1-7.
Granulocyte-monocyte apheresis is a relatively new therapy that has been proposed, sometimes with controversial results, for the treatment of inflammatory bowel disease, particularly ulcerative colitis. The aim of the present study was to perform a thorough review of the literature on the application of this type of treatment in ulcerative colitis and discuss the results, in order to provide an opinion on its use which is shared by the involved experts. The review of the literature was performed by searching PubMed with appropriate key words. The results obtained suggest that the major role for this treatment at this moment is for those patients with steroid dependency or with major contraindications to use of steroids. However, promising, albeit very preliminary, results have also been observed in steroid-naïve subjects, and this is of particular interest in consideration of the safety profile of this therapeutic method. As such, the Adacolumn may prove useful in specific subgroups of patients. Future phenotypic, genotypic, and molecular characterization of patients with inflammatory bowel disease might prove useful in defining better those subjects who might benefit most from this treatment modality.
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Mechanism and therapeutic strategy of secondary failure to anti-tumor necrosis factor-α monoclonal antibody treatment for Crohn’s disease.
Katsuyoshi Matsuoka 1, Takanori Kanai, Digestion. 2013;88(1):17-9.
It is not too much to say that infliximab has revolutionized the treatment of Crohn’s disease. However, there is the problem of ‘secondary failure’ wherein the effect may diminish during treatment. This is a much-discussed topic. For example, not all patients with secondary failure can maintain remission with dose intensification to 10 mg/kg. It is also important to make the appropriate drug selection and to clarify the optimal timing of dose intensification for achieving long-term maintenance of remission, including discussion of the first priority use of adalimumab.
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