An Open-Label Prospective Randomized Multicenter Study Shows Very Rapid Remission of Ulcerative Colitis by Intensive Granulocyte and Monocyte Adsorptive Apheresis as Compared With Routine Weekly Treatment

Sakuraba, Atsushi; Motoya, Satoshi; Watanabe, Kenji; Nishishita, Masakazu; Kanke, Kazunari; Matsui, Toshiyuki; Suzuki, Yasuo; Oshima, Tadayuki; Kunisaki, Reiko; Matsumoto, Takayuki; Hanai, Hiroyuki; Fukunaga, Ken; Yoshimura, Naoki; Chiba, Tetsuhiro; Funakoshi, Shinsuke; Aoyama, Nobuo; Andoh, Akira; Nakase, Hiroshi; Mizuta, Yohei; Suzuki, Ritsuro; Akamatsu, Taiji; Iizuka, Masahiro; Ashida, Toshifumi; Hibi, Toshifumi

doi:10.1038/ajg.2009.453

Cited by 119 publications

(127 citation statements)

References 29 publications

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“…Both reports state that, at entry, candidate patients should have a fair level of intact mucosal tissue; patients who have extensive and deep colonic lesions are not likely to benefit, while the best responders appeared to be the first-episode cases followed by steroid-naive patients. Further, Sakuraba et al [51] reported that intensive GMA (two sessions per week) was superior to weekly GMA both in efficacy rate and time to clinical remission. The report by Tanaka et al [61] is the most thorough so far on identifying the responders and non-responders to GMA.…”

Section: Clinical Efficacymentioning

confidence: 99%

“…In recent years, there has been a large number of reports from Japan [4,18,45,[48][49][50][51], as well as from Europe [46,[52][53][54][55][56] and the United States [57][58][59][60] on the efficacy of GMA in IBD. The clinical data show that GMA in patients with steroid-dependent or steroid-refractory UC was associated with significant clinical efficacy and corticosteroid tapering.…”

Section: Clinical Efficacymentioning

confidence: 99%

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The mode of actions of the Adacolumn therapeutic leucocytapheresis in patients with inflammatory bowel disease: a concise review

Hanai

Takeda

Eberhardson

et al. 2010

Clinical and Experimental Immunology

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SummaryPatients with active inflammatory bowel disease (IBD) have elevated and activated myeloid leucocytes which infiltrate the colonic mucosa in vast numbers. Myeloid leucocytes such as the CD14 + CD16 + monocytes are major sources of tumour necrosis factor (TNF)-a, and therefore selective granulocyte/monocyte (GM) adsorption (GMA) should promote remission or enhance efficacy of pharmacological therapy. However, studies in IBD have reported both impressive as well as disappointing efficacy outcomes, indicating that patients' demographic factors might determine responders or nonresponders to GMA. Nonetheless, this non-drug intervention has an excellent safety profile, and therapeutic GMA is expected to expand. In this review, attempts have been made to compile an update on the mode of actions (MoA) of the Adacolumn GMA. The MoA of GMA appears to be more than adsorption of excess neutrophils and TNF-producing CD14 + CD16 + monocytes per se. Adsorbed GMs release interleukin (IL)-1 receptor antagonist, hepatocyte growth factor and soluble TNF receptors, which are anti-inflammatory. Additionally, a sustained increase in lymphocytes including the regulatory CD4 + CD25 + T cells (lymphocyte sparing) is seen post-GMA. The impact of GMA on the immune system is potentially very interesting in the context of treating immune-related diseases. Future studies are expected to add intriguing insights to the MoA of GMA.

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Section: Clinical Efficacymentioning

confidence: 99%

Section: Clinical Efficacymentioning

confidence: 99%

The mode of actions of the Adacolumn therapeutic leucocytapheresis in patients with inflammatory bowel disease: a concise review

Hanai

Takeda

Eberhardson

et al. 2010

Clinical and Experimental Immunology

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“…[15][16][17] Several previous studies reported achieving a high remission rate in patients with active UC following GMAA therapy, and Sakuraba's group and our data suggest that intensive GMAA (twice per week) induces higher clinical and endoscopic remission compared with weekly GMAA. 18,19 In addition, our recent data and previous case series revealed that GMAA could be a suitable therapeutic option for patients with active UC prior to starting corticosteroid (CS) therapy because of a striking difference in the clinical response to GMAA between steroid-naïve and steroid-dependent patients. [19][20][21] Furthermore, it was recently reported that GMAA could be safe for UC patients with a history of CMV infection due to the avoidance of colonic CMV reactivation compared with UC patients treated with immunosuppressive drugs.…”

mentioning

confidence: 99%

Effect of intensive granulocyte and monocyte adsorptive apheresis in patients with ulcerative colitis positive for cytomegalovirus

Fukuchi

Nakase

Matsuura

et al. 2013

Journal of Crohn's and Colitis

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Background and aim: Cytomegalovirus (CMV) exacerbates ulcerative colitis (UC) refractory to immunosuppressive therapies. The conditions under which CMV reactivation occurs in patients with UC, however, is unclear. In addition, the diagnostic and treatment strategies for UC positive for CMV have not been established. Granulocyte and monocyte adsorptive apheresis (GMAA) is natural biological therapy for UC in which the granulocytes/macrophages producing inflammatory cytokines are removed. We investigated the rate of colonic CMV reactivation and the efficacy of GMAA in active UC patients positive for CMV without concomitant corticosteroid (CS) therapy. Methods: Fifty-one active UC patients without concomitant CS therapy were enrolled. Colonic CMV reactivation was examined by real-time polymerase chain reaction (PCR) using biopsy specimen and/or histological examination. All patients were treated with intensive GMAA (twice per week). Rates of clinical remission and mucosal healing were compared between UC patients positive and negative for CMV. Results: Of 51 patients, 15 (29.4%) were diagnosed as CMV positive. The clinical remission rates following intensive GMAA did not differ between UC patients positive and negative for CMV (73.3% vs 69.4%, p = 0.781). Proportion of patients achieving mucosal healing was also similar A v a i l a b l e o n l i n e a t w w w . s c i e n c e d i r e c t . c o m ScienceDirectJournal of Crohn's and Colitis (2013) 7, 803-811 Downloaded from https://academic.oup.com/ecco-jcc/article-abstract/7/10/803/378961 by guest on 07 June 2019 between these two groups. CMV-DNA became negative in all UC patients positive for CMV who achieved clinical remission 1 week after completion of intensive GMAA. Conclusions: Intestinal inflammation might trigger CMV reactivation in a subpopulation of active UC patients without CS treatment. GMAA could be a promising option for active UC positive for CMV.

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“…We also encountered a patient with CD accompanied by chronic myeloid leukemia (CML) who we successfully treated with a combination of intensive GMA and ADA (2). Intensive GMA at a rate of two GMA sessions per week has been recently shown to be more effective than conventional weekly GMA therapy for the treatment of patients with refractory UC (26). However, the safety of GMA during pregnancy remains unclear in patients with IBD because there are no meta-analysis reports of exposure to GMA during pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Maintenance of the Remission Stage of Crohn's Disease with Adalimumab Therapy during Pregnancy

et al. 2013

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A 25-year-old pregnant woman complained of abdominal pain and diarrhea. Total colonoscopy provided a diagnosis of Crohn's disease (CD) of the large intestine (Crohn's colitis). Because the patient was allergic to mesalazine, adalimumab (ADA) was used as maintenance therapy during pregnancy, following prednisolone as remission induction therapy. Remission of the patient's CD was maintained with ADA, and the patient delivered a baby girl without any difficulties. Remission of the patient's CD continued to be maintained with the administration of ADA after childbirth. We believe that this is the first report of the use of ADA therapy in a pregnant CD patient in Japan.

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An Open-Label Prospective Randomized Multicenter Study Shows Very Rapid Remission of Ulcerative Colitis by Intensive Granulocyte and Monocyte Adsorptive Apheresis as Compared With Routine Weekly Treatment

Abstract: Intensive GMA in patients with active UC seems to be more efficacious than weekly treatment, and significantly reduced the patients' morbidity time without increasing the incidence of side effects.

Cited by 119 publications

References 29 publications

The mode of actions of the Adacolumn therapeutic leucocytapheresis in patients with inflammatory bowel disease: a concise review

The mode of actions of the Adacolumn therapeutic leucocytapheresis in patients with inflammatory bowel disease: a concise review

Effect of intensive granulocyte and monocyte adsorptive apheresis in patients with ulcerative colitis positive for cytomegalovirus

Maintenance of the Remission Stage of Crohn's Disease with Adalimumab Therapy during Pregnancy

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