Case Report: Combination therapy with granulocyte apheresis and infliximab for refractory Crohn's disease

Carro, Pedro González; Roldán, F Pérez; Escribano, Óscar; Lafuente, R; Huidobro, María Luisa Legaz; Echenagusía, A. Amigo

doi:10.1002/jca.20093

Cited by 10 publications

(7 citation statements)

References 16 publications

(12 reference statements)

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“…In the clinical setting, as a nondrug intervention, weekly GMA when added to scheduled IFX maintenance therapy was effective in a CD patient with active disease while under IFX therapy. 77 This was followed by a similar report indicating that the addition of intermittent weekly GMA to scheduled IFX maintenance was effective in a CD case also refractory to IFX alone. 78 Moreover, a report investigated the efficacy of intensive GMA (two sessions per week) in combination with ADA as remission induction therapy in five consecutive cases with refractoriness to medications, including anti-TNF-α therapies such as IFX and ADA.…”

Section: Currently Available Treatmentsmentioning

confidence: 85%

Managing refractory Crohn's disease: challenges and solutions

Tanida¹,

Ozeki²,

Mizoshita³

et al. 2015

CEG

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The goals of treatment for active Crohn’s disease (CD) are to achieve clinical remission and improve quality of life. Conventional therapeutics for moderate-to-severe CD include 5-aminosalicylic acid, corticosteroids, purine analogs, azathioprine, and 6-mercaptopurine. Patients who fail to respond to conventional therapy are treated with tumor necrosis factor (TNF)-α inhibitors such as infliximab and adalimumab, but their efficacy is limited due to primary nonresponse or loss of response. It is suggested that this requires switch to another TNF-α inhibitor, a combination therapy with TNF-α blockade plus azathioprine, or granulocyte and monocyte adsorptive apheresis, and that other therapeutic options having different mechanisms of action, such as blockade of inflammatory cytokines or adhesion molecules, are needed. Natalizumab and vedolizumab are neutralizing antibodies directed against integrin α4 and α4β7, respectively. Ustekinumab is a neutralizing antibody directed against the receptors for interleukin-12 and interleukin-23. Here, we provide an overview of therapeutic treatments that are effective and currently available for CD patients, as well as some that likely will be available in the near future. We also discuss the advantages of managing patients with refractory CD using a combination of TNF-α inhibitors plus azathioprine or intensive monocyte adsorptive apheresis.

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Section: Currently Available Treatmentsmentioning

confidence: 85%

Managing refractory Crohn's disease: challenges and solutions

Tanida¹,

Ozeki²,

Mizoshita³

et al. 2015

CEG

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show abstract

“…The first case described in IBD was in 2006 in a patient with a colonic Crohn's disease with loss of response to IFX. In this case, GMA was performed every 8 weeks, alternating with IFX, filtering 1800 mL per session. With this technique, clinical and endoscopic remission was achieved.…”

Section: Discussionmentioning

confidence: 99%

Granulocyte‐Monocyte Apheresis as an Adjuvant Therapy to Anti‐Tumor Necrosis Factor Drugs for Ulcerative Colitis

et al. 2017

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Biologic anti-tumor necrosis factor (TNF) drugs have demonstrated their efficacy for the treatment of ulcerative colitis. Nevertheless, some patients will not respond to this therapy or will develop loss of response. Leukapheresis is the main non-pharmacological therapy for some immune-mediated diseases. The aim of our study was to describe our experience with this therapy in ulcerative colitis patients after loss of response to anti-TNF treatment. Leukapheresis was indicated in four patients with left-sided or extensive colitis because of partial response to biological therapy or secondary loss of response to it. All patients received 8 to 10 sessions in an intensive regimen. Globally, a decrease in the Mayo score was observed. The overall response rate was 50% with one patient who displayed sustained response. No patients have required colectomy during follow-up. Adjuvant treatment with leukapheresis in patients with inadequate response to anti-TNF treatment showed some beneficial effect, although of limited duration, in patients with ulcerative colitis.

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“…GMA by depleting activated white blood cells and inflammatory cytokines including TNF could improve the efficacy of the immunosuppressive treatment. Several cases reported in the literature suggest that the addition of weekly GMA to scheduled Infliximab or Adalimumab maintenance therapy is effective in IBD patients refractory to anti‐TNFα treatments as mono‐therapy without interfering with the serum concentration of anti‐TNFα .…”

Section: Discussionmentioning

confidence: 99%

Efficacy of a Novel Granulocyte Monocyte Apheresis Adsorber Device in the Treatment of Inflammatory Bowel Diseases: A Pilot Study

et al. 2016

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Granulocyte monocyte apheresis (GMA) is a non-pharmacological treatment for inflammatory bowel disease. In our study, we tested a novel GMA adsorber device in terms of clinical efficacy and safety in patients' non-response to pharmacological therapy. Secondary outcomes were the evaluation of adsorber's technical performance, the reduction of inflammatory markers and the improvement of patients' life quality. The prospective study included 18 patients enrolled from 2011 to 2012 with a monitoring of 48 weeks. All patients with Crohn's disease achieved a clinical remission after GMA treatments, sustained until the end of follow up, while 80% of ulcerative colitis patients obtained a clinical benefit, maintained after 48 weeks of monitoring. Leukocytes, neutrophils, monocytes and platelets, compared to erythrocytes and lymphocytes, were effectively removed from peripheral blood. There was no statistically significant result about serological markers of inflammation. A consistent improvement of the patients' quality of life was observed up to the end of follow up. No significant side-effects were recorded. Our study underlines the efficacy and the safety of this novel GMA adsorber device; a prospective randomized clinical trial with adequate sample size should be performed.

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Case Report: Combination therapy with granulocyte apheresis and infliximab for refractory Crohn's disease

Cited by 10 publications

References 16 publications

Managing refractory Crohn's disease: challenges and solutions

Managing refractory Crohn's disease: challenges and solutions

Granulocyte‐Monocyte Apheresis as an Adjuvant Therapy to Anti‐Tumor Necrosis Factor Drugs for Ulcerative Colitis

Efficacy of a Novel Granulocyte Monocyte Apheresis Adsorber Device in the Treatment of Inflammatory Bowel Diseases: A Pilot Study

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Case Report: Combination therapy with granulocyte apheresis and infliximab for refractory Crohn's disease

Cited by 10 publications

References 16 publications

Managing refractory Crohn&#39;s disease: challenges and solutions

Managing refractory Crohn&#39;s disease: challenges and solutions

Granulocyte‐Monocyte Apheresis as an Adjuvant Therapy to Anti‐Tumor Necrosis Factor Drugs for Ulcerative Colitis

Efficacy of a Novel Granulocyte Monocyte Apheresis Adsorber Device in the Treatment of Inflammatory Bowel Diseases: A Pilot Study

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Product

Resources

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Managing refractory Crohn's disease: challenges and solutions

Managing refractory Crohn's disease: challenges and solutions