Hiroki Tanaka, Satoshi Motoya, Tomoyoshi Shibuya, Satoshi Tanida, Seiichiro Kokuma, Eiji Hosoi Gastroenterology 2018 154 (6) Suppl.S-996–S-997

Background: There are few studies on the usefulness of granulocyte and monocyte adsorptive apheresis (GMA) in elderly patients with inflammatory bowel disease (IBD). We investigated the safety and effectiveness of GMA in elderly patients who participated in the Post-marketing Surveillance Study of GMA Using Adacolumn® for Patients with Inflammatory Bowel Disease Who Have Special Situations (PARTICULAR). Methods: The PARTICULAR study is a retrospective, multicenter cohort study that included patients with ulcerative colitis (UC) or Crohn’s disease (CD) who received GMA between November 2013 and March 2017. Patients with at least one special situation, including elderly patients, patients with anemia, and patients undergoing concomitant treatment with multiple immunosuppressants (IMs) were enrolled. Patients aged # 64 years were excluded from this study. GMA was performed using Adacolumn® (JIMRO, Takasaki, Japan). Each patient received up to a maximum of 11 GMA sessions. The safety of GMA was assessed in all patients. The effectiveness of GMA was assessed in patients with UC with a partial UC disease activity index (pUC-DAI) score of $ 3. Remission was defined as a pUC-DAI score of # 2. Patients receiving concomitant treatment with infliximab, adalimumab, or calcineurin inhibitors were excluded from the effectiveness assessment. The incidence of adverse events (AEs) and remission rates were compared between elderly patients with and without any special situation using univariate and multivariate logistic regression analysis. Results: A total of 125 elderly patients (118 UC, 7 CD) from 93 institutions were included. The median age was 73.2 years. Fifty-six patients did not have any special situation, and 69 had at least one or more special situations. The incidence of AEs was 11.2% in all patients. The incidence of AEs was significantly lower in elderly patients without any special situation (3.6%) than in those with at least one or more special situations (17.4%) (Figure 1A). AEs significantly occurred in elderly patients with anemia (21.9%) and on multiple concomitant IMs (23.8%) compared to those without any special situation (3.6%). Anemia and multiple concomitant IMs were identified as independent predictors for a higher incidence of AEs (Table 1). The effectiveness of GMA was assessed in 92 patients with UC. The remission rate was 48.9%. No difference was observed in the remission rate between elderly patients without any special situation (52.2%) and those with at least one or more special situations (45.7%) (Figure 1B). Conclusions: A low incidence of AEs (3.6%) was found in elderly IBD patients receiving GMA without any special situation. Remission was achieved by GMA in 48.6% of the elderly UC patients. Care should be taken when using GMA in elderly IBD patients with anemia or on multiple concomitant IMs

Chie Kurihara Toshihide Ohmori Shingo Kato Koji Yakabi Satoshi Mochida Soichiro Miura Gastroenterology 2017 152 (5) Suppl. S764

Background: The number of the elderly patients of ulcerative colitis (UC) is growing as the population ages. Because elderly patients with UC sometimes become refractory to treatment, it is important to select an appropriate induction therapy for elderly patients at the early phase of UC disease. To predict which therapy is effective before treatment will be useful for the decision of later therapeutic strategy. Granulocyte and monocyte adsorptive apheresis (GMA) that was developed for selective depletion of activated granulocytes and monocytes/
macrophages from peripheral blood is non-pharmacological therapy for inflammatory bowel disease. It is beneficial than the other therapy in the point that it has fewer side effects. GMA is effective and safe as induction therapy in UC, and commonly used in Asia and north Europe. GMA is one of hopeful candidate of elderly therapy. We investigated the relationship between therapeutic efficacy of GMA and age, and examined whether mRNA expressions of cytokines and chemokines in colonic mucosa showed presence of age-related change. Methods: Thirty-two active UC patients, mean age 36.7 years, range 14-70 years, were enrolled in this study. All patients received 10 or 11 times of GMA, and colonoscopies were applied before the first GMA and after the last GMA. Assessment of disease activity and colonic mucosal healing were determined based on Mayo score. In this study, elderly patients were defined as those >55 years of age. mRNA expressions of cytokines and chemokines were determined by quantitative RT-PCR using biopsy specimen of colonic mucosa. Results: There were no significant differences in sex, duration of disease, location of disease, CRP, WBC and Mayo score before the first GMA treatment between elderly group and non-elderly group. After the last GMA session, the ratios of mucosal healing in elderly group and non-elderly group were 2 of 6 (33.3%) and 16 of 26 (61.5%), respectively. In all patients, before treatment of GMA, mucosal healing group showed significantly higher mRNA expression of inflammatory cytokines and chemokines such as MIP-1β, TNFα, IL1β and IL8 in colonic mucosal tissue than that of non-mucosal healing group (P <0.05). In particular, in elderly group, the degree of mRNA expression of MIP-1β and IL23 in colonic mucosa before GMA treatment was higher in mucosal healing group than in non-mucosal healing group (P <0.05). High expressions of MIP-1β and IL23 showed sensitivity, specificity, positive predictive value and negative predictive value of 100% as a marker of mucosal healing after GMA in elderly group. Conclusion: Mucosal IL23 and MIP-1β mRNA expression before treatment in elderly were significantly higher in responder than non-responder to GMA treatment. We propose that measuring of expression of these molecules is useful to expect therapeutic efficacy of GMA in elderly patients with UC.

https://www.gastrojournal.org/action/doSearch?text1=mo1730&field1=AllField

Chiharu Tominaga ¹, Masaaki Yamamoto ¹, Yasutomo Imai ¹, Kiyofumi Yamanishi ¹ , Case Rep Dermatol. 2015 Feb 21;7(1):29-35.

 She is the oldest reported case of GPP with a deficiency of interleukin-36 receptor antagonist (DITRA), although GPP in DITRA has been suggested to usually occur in younger cases with no pre-existing psoriasis vulgaris.

https://pubmed.ncbi.nlm.nih.gov/25848350/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4357681/pdf/cde-0007-0029.pdf