Therapeutic effect of intensive granulocyte and monocyte adsorption apheresis combined with thiopurines for steroid- and biologics-naïve Japanese patients with early-diagnosed Crohn’s disease

Abstract

BackgroundEarly induction with biologics can reduce complications in patients with Crohn’s disease (CD) and improve their quality of life. The safety of biologics, however, is uncertain. Granulocyte and monocyte adsorptive apheresis (GMAA) is a natural biologic therapy that selectively removes granulocytes and monocytes/macrophages and has few severe adverse effects. The effects of GMAA on patients with early-diagnosed CD are unclear. We investigated the effects of GMAA combined with thiopurines on patients with early-diagnosed CD.MethodsTwenty-two corticosteroid- and biologic-naïve patients with active early-diagnosed CD were treated with intensive GMAA (twice per week) combined with thiopurines administration. Active early-diagnosed CD was defined as follows: (i) within 2years after diagnosis of CD, (ii) with no history of both surgical treatment and endoscopic dilation therapy, and (iii) Crohn’s Disease Activity Index (CDAI) was higher than 200. We investigated the ratios of clinical remission defined as CDAI was less than or equal to 150 at 2, 4, 6 and 52weeks and mucosal healing defined as a Simplified Endoscopic Activity Score for Crohn’s Disease (SES-CD) as 0 at 6 and 52weeks. Adverse events were recorded at each visit.ResultsThe ratios of clinical remission at 2, 4, and 6 weeks were 6 of 22 (27.2%), 12 of 22 (54.5%), and 17 of 22 (77.2%), respectively. At 52 weeks, 18 of 21 patients (81.8%) were in clinical remission. The ratios of mucosal healing at 6 and 52 weeks were 5 of 22 (22.7%) and 11 of 22 (50%), respectively. The difference in the mucosal healing ratio was significant between 6 and 52 weeks (p = 0.044). No serious adverse effects were observed during this study.ConclusionsCombination therapy with intensive GMAA and thiopurines administration rapidly induced high remission in patients with active early-diagnosed CD without serious adverse effect. Mucosal healing was observed in 50.0% of enrolled patients. This combination therapy might be a rational option for patients with early-diagnosed CD.

Pyoderma Gangrenosum with Ulcerative Colitis Successfully Treated by the Combination of Granulocyte and Monocyte Adsorption Apheresis and Corticosteroids

“…In contrast, no reports have described opportunistic infection occurring in association with GMA treatment. The excellent safety profile of GMA has been confirmed in numerous studies (9,27,28), and makes GMA an attractive option for patients who are refractory to conventional therapy.…”

Combination Therapy With Intensive Granulocyte and Monocyte Adsorptive Apheresis Plus Ustekinumab in Patients With Refractory Crohn's Disease

“…No data have yet shown endoscopic improvements with intensive GMA monotherapy in active CD patients . However, a prospective cohort investigating the 52‐week efficacy and endoscopic outcomes of intensive GMA combined with thiopurines in corticosteroids‐ and TNF‐α biologic‐naïve patients with early‐diagnosed CD (mean CDAI, 260) showed that the rate of mucosal healing (SES‐CD = 0) at week 6 was 22.7% . Moreover, a clinical study of combination therapy with intensive GMA plus ADA in five cases with moderately to severely active CD that had proved refractory to conventional pharmacotherapy including TNF‐α antagonists, showed that all five cases achieved clinical remission by week 10, together with marked healing of CD mucosal lesions, and that this combination therapy with intensive GMA plus ADA was thus very effective .…”

Efficacy of cytapheresis for remission induction and dermatological manifestations of ulcerative colitis

“…However, our opinion is that cytapheresis should be the first choice in first episode cases as well as in drug naïve cases. Patients who receive cytapheresis at an early stage of their IBD are known to respond well to a second course of cytapheresis upon a relapse . One advantage of cytapheresis is that extra‐intestinal lesions may also respond along with a fall in CAI.…”

“…Patients who receive cytapheresis at an early stage of their IBD are known to respond well to a second course of cytapheresis upon a relapse. [32][33][34] One advantage of cytapheresis is that extra-intestinal lesions may also respond along with a fall in CAI. There are also patients who are intolerant to certain pharmacologicals or wish not to receive corticosteroids.…”