Iago Rodríguez-Lago 1, José Manuel Benítez 2, Valle García-Sánchez 2, Ana Gutiérrez 3, Laura Sempere 4, Daniel Ginard 5, Manuel Barreiro-de Acosta 6, José Luis Cabriada 7 , Gastroenterol Hepatol. Aug-Sep 2018;41(7):423-431.
Tag: ulcerative colitis
Scientific corner
Granulocyte and monocyte apheresis in inflammatory bowel disease: The patients’ point of view.
Granulocyte and monocyte apheresis is well tolerated and accepted by patients with IBD. Although we found no significant differences according to type of IBD or apheresis regimen, patient perception was affected by clinical effectiveness.
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Mucosal Cytokine Profiles After Induction Therapy With Granulocyte/Monocyte Apheresis in New-onset Inflammatory Colitis.
Helena Rolandsdotter 1 2, Kerstin Jönsson-Videsäter 3 4, Ulrika L Fagerberg 5 6, Michael Eberhardson 1 7, Yigael Finkel 1 2 , J Pediatr Gastroenterol Nutr. 2018 Apr;66(4):e103-e107.
We speculate that the decreases in colonic mucosal cytokine profiles after treatment may explain the observed clinical efficacy in the GMA-treated children with IBD.
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Changes in Treatment with Granulocyte and Monocyte Adsorptive Apheresis from the Past to Future in Patients with Inflammatory Bowel Disease
Shingo Kato, Akira Ishibashi, Kaori Sugiura, Kazuhito Kani, Tomonari Ogawa, Hajime Hasegawa, Koji Yakabi, Contrib Nephrol 2018;196:200-208.
GMA decreases inflammatory cytokines and upregulates regulatory T cells. Intensive GMA is significantly more effective than weekly GMA in patients with IBD. The frequency of GMA sessions per week positively correlates with treatment effects. GMA can be safely used in pregnant women and children because of its low adverse event rates. Maintenance therapy and rescue therapy for loss of response of anti-tumor necrosis factor (TNF)-α antibodies are effective. Optimal patients who responded to combination therapy with infliximab and GMA showed aggravation characteristics against infliximab treatment at week 4. Key Message: Prospective randomized blinded studies using a sham column should be performed for the loss of response against anti-TNF-α antibodies.
anti-TNFα / Clinical remission / Crohn's disease / cytokines / immunology / maintenance / pediatry / Pregnancy / Safety / special situations / Tregs / ulcerative colitis /
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Evidence-based clinical practice guidelines for inflammatory bowel disease
Katsuyoshi Matsuoka 1, Taku Kobayashi 1, Fumiaki Ueno 2 3, Toshiyuki Matsui 1, Fumihito Hirai 1, Nagamu Inoue 1, Jun Kato 1, Kenji Kobayashi 1, Kiyonori Kobayashi 1, Kazutaka Koganei 1, Reiko Kunisaki 1, Satoshi Motoya 1, Masakazu Nagahori 1, Hiroshi Nakase 1, Fumio Omata 1, Masayuki Saruta 1, Toshiaki Watanabe 1, Toshiaki Tanaka 1, Takanori Kanai 1, Yoshinori Noguchi 1, Ken-Ichi Takahashi 1, Kenji Watanabe 1, Toshifumi Hibi 1, Yasuo Suzuki 1, Mamoru Watanabe 1, Kentaro Sugano 1, Tooru Shimosegawa 1 , J Gastroenterol. 2018 Mar;53(3):305-353.
Inflammatory bowel disease (IBD) is a chronic disorder involving mainly the intestinal tract, but possibly other gastrointestinal and extraintestinal organs. Although etiology is still uncertain, recent knowledge in pathogenesis has accumulated, and novel diagnostic and therapeutic modalities have become available for clinical use. Therefore, the previous guidelines were urged to be updated. In 2016, the Japanese Society of Gastroenterology revised the previous versions of evidence-based clinical practice guidelines for ulcerative colitis (UC) and Crohn’s disease (CD) in Japanese. A total of 59 clinical questions for 9 categories (1. clinical features of IBD; 2. diagnosis; 3. general consideration in treatment; 4. therapeutic interventions for IBD; 5. treatment of UC; 6. treatment of CD; 7. extraintestinal complications; 8. cancer surveillance; 9. IBD in special situation) were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases. The guidelines were developed with the basic concept of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Recommendations were made using Delphi rounds. This English version was produced and edited based on the existing updated guidelines in Japanese.
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Inflammatory bowel disease patients experiencing a loss of response to infliximab regain long-term response after undergoing granulocyte/monocyte apheresis: A case series.
Yoko Yokoyama 1, Koji Kamikozuru 2, Kenji Watanabe 2, Shiro Nakamura 2 , Cytokine. 2018 Mar;103:25-28.
To our best knowledge, this is the first report of adding a non-drug GMA to restore the efficacy of infliximab. The outcomes, albeit in three cases, are relevant in therapeutic settings and should inspire further studies in a larger number of patients.
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Cytapheresis (CAP) with leukocyte removal filter/bead column as onetherapeutic option for inflammatory bowel disease
Koji Sawada 1 , Transfus Apher Sci. 2017 Oct;56(5):689-697.
Clinical studies with these two new models have shown good effects for active IBD. Clinical data suggest that leukocytapheresis might be an effective adjunct to therapy of IBD, to promote remission, taper conventional drug dosage and potentially should reduce the number of patients who require colectomy. The results may further understandings of the pathophysiology of IBD and this in turn should contribute to a more effective treatment of this disorder.
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Treatment options for children and adolescents with Inflammatory Bowel Disease: Is granulomonocytapheresis an effective alternative to drug therapy?
Tomotaka Tanaka 1, Takayuki Yamamoto 2, Koji Sawada 3, Rodolfo Sacco 4 , Expert Rev Gastroenterol Hepatol. 2017 Aug;11(8):749-758.
Patients with inflammatory bowel diseases (IBD) require life-long medications, which even if effective have the potential to cause adverse effects as additional morbidity factors. In pediatric patients, drug therapy has more serious limitations, including impaired physical and mental development. A non-drug therapeutic option is believed to be depletion of elevated and activated granulocytes and monocytes known to release inflammatory cytokines, like the CD14+CD16+ monocyte phenotype known to release tumor necrosis factor-α. Areas covered: Granulomonocyteapheresis (GMA) with an Adacolumn as a treatment option for IBD patients has been applied for the past 15 years. This article reviews the argument that GMA is a relevant and effective non-pharmacologic intervention in pediatric IBD setting. Expert commentary: GMA with an Adacolumn has shown promise in adult, pediatric, and adolescent patients with active IBD. There is evidence of post-GMA immunomodulation in terms of increased regulatory T-cell and B-cell activities. Additionally, patients who respond to GMA may attain a favorable long-term clinical course by avoiding pharmacologicals during an early phase of their active IBD. GMA has a good safety profile, especially in difficult-to-treat and pediatric settings. An additional trial is warranted to assess the efficacy of GMA in the early phase of pediatric IBD to optimize patient selection.
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Adsorptive Depletion of Myeloid Lineage Leucocytes as Remission Induction Therapy in Patients with Ulcerative Colitis after Failure of First-Line Medications: Results from a Three-Year Real World, Clinical Practice
Takayuki Iida 1, Kentaro Ikeya, Masaichi Kato, Jinro Abe, Masayoshi Yamamoto, Fumitoshi Watanabe, Ken Sugimoto, Hiroyuki Hanai , Digestion. 2017;96(2):119-126.
Corticosteroid-naïve patients appeared to benefit the most from the Adacolumn GMA, and attain a favourable long-term clinical course. Accordingly, GMA should be a first-line therapy in this clinical setting.
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Long-interval Cytapheresis as a Novel Therapeutic Strategy Leading to Dosage Reduction and Discontinuation of Steroids in Steroid-dependent Ulcerative Colitis
Masahiro Iizuka 1 2, Takeshi Etou 2, Makoto Kumagai 3, Atsushi Matsuoka 3, Yuka Numata 3, Shiho Sagara 1 , Intern Med. 2017 Oct 15;56(20):2705-2710.
Conclusion We confirmed that LI-CAP has therapeutic effects on reducing the dosage and discontinuing steroids in patients with steroid-dependent UC.
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Letter to Yokoyama et al. (Yokoyama Y. Cytokine. 2017 Dec 29; 103: 25–28)
Iago Rodríguez-Lago 1, José Luis Cabriada 2 , Cytokine. 2018 Apr;104:29.
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