Masami Kumagai 1, Yasuhiko Yamato, Kohji Maeda, Eisuke Nakashima, Kosuke Ushijima, Akihiko Kimura,Pediatr Int. 2007 Aug;49(4):431-6.
Tag: digestive
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Extracorporeal leukocyte removal therapy for patients with ulcerative colitis
Additional studies are needed to determine optimum timing of LCAP or GCAP and initiation of remission-maintenance therapy.
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Granulocytapheresis in inflammatory bowel disease Efficacy of an induction plus maintenance sessions protocol at 32 weeks
F J Fernández Pérez 1, F Rodríguez, C de Sola, N Fernández Moreno, F Vera, R Rivera, A Sánchez Cantos, Rev Esp Enferm Dig. 2007 Nov;99(11):628-35.
Introduction: Granulocytapheresis (GCAP) eliminates activated granulocytes-monocytes from peripheral blood, thus modifying the circulating pool of leukocytes and reducing intestinal inflammation. Objective: To evaluate the efficacy of GCAP in inflammatory bowel disease (IBD) using an induction and maintenance protocol. Material and method: A retrospective study including patients with active corticosteroid-dependent or refractory IBD. Induction included 5 sessions in ulcerative colitis (UC) and 7 sessions in Crohn’s disease (CD); one monthly session was used thereafter until week 32. Clinical activity indices and use of corticosteroids were monitored. Results: Eighteen patients were included (10 with UC, 8 with CD), 10 of them dependent on and 8 refractory to corticosteroids. Fourteen of them were refractory and a further 4 were intolerant to immunosuppressants (IS). Induction was not completed in 2 UC (severe relapses) and 1 CD (side-effects) patients. One UC and 3 CD patients withdrew during maintenance. Among patients who completed induction, response or remission was achieved in 87.5% of UC cases (2 and 5 patients) and 71.4% of CD cases (1 and 4 patients), respectively. At week 32 response-remission rates reached 75% in CU (3 and 3 patients) and 42.8% in CD (1 and 2 patients) cases, respectively. Corticosteroid withdrawal was possible in 14.2% of CD and in 62.5% of UC patients (25% in remission and 37.5% with response). There were two major side effects (thrombophlebitis and syncope). No colectomies were performed for UC patients who completed GCAP induction after a mean follow-up of 97.6 weeks (range: 72-128). Conclusions: Both UC and CD respond well to GCAP induction. At 32 weeks UC patients maintain similar response-remission rates (87.5 vs. 75%), whereas almost one-third of CD patients lose response. Granulocytapheresis is an alternative, steroid-sparing treatment modality to induce and maintain remission in UC, while good patient selection and a maintenance protocol not well defined yet are needed for CD.
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Therapeutic leukocytapheresis for inflammatory bowel disease
Abbi R.Saniabadi, HiroyukiHanai, KenFukunaga, KojiSawada, ChikakoShima, IngvarBjarnason, RobertLofberg, https://doi.org/10.1016/j.transci.2007.08.003
The inference that granulocytes and monocytes/macrophages (GM) are part of the immunopathogenesis of inflammatory bowel disease (IBD) and hence should be targets of therapy stems from observations of elevated, and activated GM in patients with IBD. The Adacolumn can selectively deplete GM by adsorption (GMA) and in patients with IBD. GMA has been associated with significant clinical efficacy together with sustained suppression of inflammatory cytokine profiles. Additionally, GMA depleted proinflammatory CD14+CD16+ monocytes and was followed by an increase in CD4+ T lymphocytes including the regulatory CD4+CD25high+Foxp3 phenotype. Hence, GMA could be a non-pharmacologic therapy for IBD with potential to spare steroids and other unsafe pharmacologic preparations.
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Leucocyte apheresis in the treatment of paediatric ulcerative colitis
Tarja Ruuska, Marja-Leena Lähdeaho, Yelda Sutas, Merja Ashorn, Juhani Grönlund, Scand J Gastroenterol. 2007 Nov;42(11):1390-1.
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Granulocytapheresis: Old procedures, new solution
M P Martínez Montiel, Rev Esp Enferm Dig. 2007 Nov;99(11):623-7.
To conclude, granulocytapheresis is a well-tolerated immunomodulating therapy with few side effects and good results in the management of corticoid-dependent or resistant UC, naïve patients, and pediatric subjects; it could be even considered during pregnancy. Results are less clear in CD. Some aspects remain to be elucidated, including session number and duration, and a potential maintenance regimen. Pharmacoeconomics studies are necessary to find the proper place for this technique within
IBD treatment algorithms. Therapy strategies will likely be developed in the future that will combine GMCAP with immunosuppressants and/or biological therapies
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Treatment of inflammatory immunologic disease: Leukocytapheresis for inflammatory immunologic disease (tentative)
Mamoru Watanabe 1, Daisuke Kubota, Masakazu Nagahori, Takanori Kanai , Intern Med
. 2007;46(16):1305-6.
Opinion about effectiviness, safety , number of treated patientes and potential indications of LCAP and GMA.
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Factors affecting clinical and endoscopic efficacies of selective leucocytapheresis for ulcerative colitis
T Yamamoto 1, A R Saniabadi, Y Maruyama, S Umegae, K Matsumoto, Dig Liver Dis. 2007 Jul;39(7):626-33.
Based on the outcomes of this study, it appears that steroid-naïve patients and patients on low dose steroid and short duration of exposure respond to granulocyte, monocyte/macrophage adsorptive apheresis. Further studies in larger cohorts of patients should strengthen our findings.
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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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Treatment of patients with acute ulcerative colitis: conventional corticosteroid therapy (MP) versus granulocytapheresis (GMA): a pilot study
Granulocytapheresis represents a new and promising approach to active ulcerative colitis. In fact, even if more expensive than conventional corticosteroids, it seems slightly more effective and, above all, with side effects much less frequent and serious. Thus, granulocytapheresis cycles could be prolonged or repeated, if necessary, in more severe diseases without significant risks for the patients.
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Granulocytapheresis (GCAP) for severe alcoholic hepatitis-A preliminary report
Ryukichi Kumashiro 1, Yuriko Koga, Reiichirou Kuwahara, Tatsuya Ide, Teruko Hino, Kazuo Tanaka, Akiko Hisamochi, Kei Ogata, Yukari Takao, Hiroyuki Koga, Hidemi Nishida, Seiya Okuda, Teruo Sakamoto, Michio Sata, Hepatol Res. 2006 Nov;36(3):229-36.
GCAP therapy deserves further evaluation as a new therapeutic modality for a moderately severe alcoholic hepatitis.
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