Mamoru Watanabe 1, Daisuke Kubota, Masakazu Nagahori, Takanori Kanai , Intern Med
. 2007;46(16):1305-6.
Tag: Crohn's disease
Scientific corner
Treatment of inflammatory immunologic disease: Leukocytapheresis for inflammatory immunologic disease (tentative)
Opinion about effectiviness, safety , number of treated patientes and potential indications of LCAP and GMA.
Scientific corner
Quality of life in patients with active ulcerative colitis treated with selective leukocyte apheresis
Lena Oxelmark 1, Pernilla Hillerås, Axel Dignass, Joachim Mössner, Stefan Schreiber, Wolfgang Kruis, Robert Löfberg, Scand J Gastroenterol. 2007 Mar;42(3):406-7.
Scientific corner
Leukocytapheresis as promising therapy for inflammatory bowel disease
R Caprilli 1, V D’Ovidio, Dig Liver Dis. 2007 May;39(5):435-7.
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Leukocytapheresis: Filtering Out the Facts
P. Irving D S Rampton 2007 chapter 29 part 3 Medical treatment: What’s Round the corner? DOI:10.1002/9780470750827.ch29
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Role of leukocytapheresis in the management of inflammatory bowel disease
Ken Fukunaga, Hiroto Miwa, Takayuki Matsumoto January 2007 Tropical gastroenterology: official journal of the Digestive Diseases Foundation 28(1):11-5
Ulcerative colitis (UC) together with Crohn’s disease (CD) constitute idiopathic inflammatory bowel diseases (IBD) of the gut. The etiology of IBD is poorly understood, but autoimmune-disturbance has been suggested to play an important role in this incurable disease. Extracorporeal leukocyte removal therapy (ELRT) is the latest adjunct for IBD patient refractory to steroids, and it aims at suppressing immunological response by removing circulating leukocytes, especially granulocytes, from the blood stream. The present paper reviews the latest evidences in order to propose the current status of ELRT in the therapeutic strategy for IBD, especially for UC and CD. Clinical experience so far suggests that ELRT has superior efficiency as a non-pharmacological immuno-modulative therapy for steroid resistant UC patients before submission to colectomy. Moreover, ELRT has been proven to be a safe therapy compared with other current medications for severe UC.
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Pilot Feasibility Studies of Leukocytapheresis With the Adacolumn Apheresis System in Patients With Active Ulcerative Colitis or Crohn Disease
Bruce E Sands 1, William J Sandborn, Douglas C Wolf, Seymour Katz, Michael Safdi, David A Schwartz, Stephen B Hanauer, J Clin Gastroenterol. 2006 Jul;40(6):482-9.
Treatment with Adacolumn may be feasible and effective in patients with moderate-to-severe refractory inflammatory bowel disease. Larger sham-controlled studies are ongoing.
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Preliminary data on the use of apheresis in inflammatory bowel disease
William J Sandborn, Inflamm Bowel Dis. 2006 Jan;12 Suppl 1:S15-21
Multiple studies have suggested that selective apheresis may be of benefit as a steroid-sparing treatment. In an unblinded randomized trial in 69 steroid-dependent patients with active UC randomized to selective apheresis with Adacolumn or an increased dose of prednisolone, 83% of patients receiving Adacolumn achieved remission compared with 65% of those receiving an increased dose of prednisolone. In another uncontrolled study of 60 patients with active UC, treatment with Adacolumn selective apheresis enabled nearly 70% of steroid-dependent patients to discontinue prednisolone. An unblinded randomized controlled trial of a different selective apheresis device (Cellsorba) versus high-dose prednisolone in patients with active UC showed a greater therapeutic effect (74%) than high-dose prednisolone (38%) and lower frequency of adverse effects (24% versus 68%).
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Down-regulation of interfeferon-γ parallels clinical response to selective leukocyte apheresis in patients with inflammatory bowel disease:a 12-month follow-up study
V Muratov 1, J Lundahl, A K Ulfgren, K Elvin, I Fehrman, N Ahlborg, A Ost, N Hittel, A Saniabadi, R Löfberg, Int J Colorectal Dis . 2006 Sep;21(6):493-504.
Leukocyte apheresis is a novel and safe nonpharmacological adjunct therapy that may prove useful in steroid refractory or dependent patients when conventional drugs have failed. Down-regulation of IFN-gamma in mucosal biopsies and in peripheral leukocytes may be a predictive marker for sustained, long-term response.
Scientific corner
Positions of selective leukocytapheresis in the medical therapy of ulcerative colitis
Hiroyuki Hanai, World J Gastroenterol. 2006 Dec 21;12(47):7568-77.
The Adacolumn is a medical device developed for selective depletion of GM by receptor-mediated adsorption (GMA). Clinical data show GMA, in patients with steroid dependent or steroid refractory UC, is associated with up to 85% efficacy and tapering or discontinuation of steroids, while in steroid naive patients (the best responders), GMA spares patients from exposure to steroids. Likewise, GMA at appropriate intervals in patients at a high risk of clinical relapse suppresses relapse thus sparing the patients from the morbidity associated with IBD relapse. Further, GMA appears to reduce the number of patients being submitted to colectomy or exposure to unsafe immunosupressants. First UC episode, steroid naivety and short disease duration appear good predictors of response to GMA and based on the available data, GMA seems to have an excellent safety profile.
Scientific corner
Treatment of active steroid-refractory inflammatory bowel diseases with granulocytapheresis: Our experience with a prospective study
Bresci Giampaolo 1, Parisi Giuseppe, Bertoni Michele, Mazzoni Alessandro, Scatena Fabrizio, Capria Alfonso, World J Gastroenterol. 2006 Apr 14;12(14):2201-4.
Even if the number of our patients with steroid-refractory IBDs was not big, we can assert that GCAP is well tolerated and effective, especially in the first six months after the treatment, in a significant percentage of cases. The rate of sustained response drops slightly after 6 mo and significantly after 12 mo, however the absence of severe side effects can be a stimulus for further evaluating new schedules of treatment.
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