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

Nomura, Osamu; Osada, Taro; Shibuya, Tomoyoshi; Ishikawa, Dai; Haga, Keiichi; Kodani, Tomohiro; Sakamoto, Naoto; Ogihara, Tatsuo; Yamaji, Katsuhiko; Watanabe, Sumio

doi:10.1002/jca.21555

Cited by 5 publications

(3 citation statements)

References 35 publications

(78 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[18][19][20] Moreover, there have been reports that the combination of cytapheresis and prednisolone improved PG associated with IBD. 21,22 In the present case, though we could not completely deny the possibility of PG as a side effect of VED, we did not strongly suspect it as an adverse event. This patient may have benefited from anti-TNF therapy until she discontinued GLM, and she might have had a relapse of a quiescent EIM because of switching to VED.…”

Section: Discussioncontrasting

confidence: 68%

Pyoderma gangrenosum in an ulcerative colitis patient during treatment with vedolizumab responded favorably to adsorptive granulocyte and monocyte apheresis

Shibuya

Haga

Saeki

et al. 2020

J of Clinical Apheresis

Self Cite

View full text Add to dashboard Cite

Pyoderma gangrenosum (PG) is an extra‐intestinal skin lesion in inflammatory bowel disease (IBD) as is erythema nodosum. Vedolizumab (VED) is a monoclonal antibody that targets α4β7 integrin and has an intestinal selective mechanism. Despite good therapeutic effects on colitis, the effect on extra‐intestinal manifestations (EIMs) remains unclear. Here we report a case of ulcerative colitis complicated by PG during treatment with VED, which was successfully treated with prednisolone in combination with adsorptive granulocyte and monocyte apheresis (GMA). The patient was a 50‐year‐old woman with a past medical history of extensive ulcerative colitis managed by golimumab (GLM). She developed flare symptoms due to loss of response to GLM, and treatment was switched to VED. Her gastrointestinal symptoms were improved with VED treatment with less frequent bowel movements. However, infiltrative erythema with pain appeared on the right lower leg and right knee, and expanded and gradually ulcerated. Her skin lesions were treated with corticosteroid, but showed poor improvement. Therefore, granulocyte and monocyte apheresis (GMA) treatment was administered in combination with prednisolone. After 3 months, the ulcer gradually improved, and at the time of this writing, the eruptions were nearly replaced by epithelial tissue. This case study showed that patients with UC and EIMS may respond well to combination therapy of VED and GMA. GMA has a very favorable safety profile. On the other hand, the causal connection between VED and PG is still unclear. We believe that a combination therapy involving VED and GMA in IBD patients with EIMs warrants consideration.

show abstract

Section: Discussioncontrasting

confidence: 68%

Pyoderma gangrenosum in an ulcerative colitis patient during treatment with vedolizumab responded favorably to adsorptive granulocyte and monocyte apheresis

Shibuya

Haga

Saeki

et al. 2020

J of Clinical Apheresis

Self Cite

View full text Add to dashboard Cite

show abstract

“…Hitherto, a large number of articles mostly from Japan, [51][52][53][54][55][56][57][58][59][60][61][62][63] Europe, [64][65][66][67][68][69][70][71][72][73][74][75][76][77] and the USA 78,79 have described the efficacy of GMA in patients with IBD. The clinical application of GMA with the Adacolumn began following a pioneering multicentre clinical trial by Shimoyama, et al 80 Since then, GMA has been widely applied in Japan and in the European Union (EU) countries to treat patients with IBD.…”

Section: Clinical Efficacy Of Gma In Patients With Ucmentioning

confidence: 99%

Granulomonocytapheresis as a cell‐dependent treatment option for patients with inflammatory bowel disease: Concepts and clinical features for better therapeutic outcomes

Saniabadi

Tanaka

Yamamoto

et al. 2018

J of Clinical Apheresis

View full text Add to dashboard Cite

Ulcerative colitis (UC) and Crohn's disease (CD) are major phenotypes of the chronic inflammatory bowel disease (IBD), which afflicts millions of individuals throughout the world with debilitating symptoms. The chronic nature of IBD means that patients require life‐long medications, and this may lead to drug dependency, loss of response together with adverse side effects as additional morbidity factors. The efficacy of antitumour necrosis factor (TNF)‐α biologics has validated the role of inflammatory cytokines notably TNF‐α in the exacerbation and perpetuation of IBD. However, cytokines are released by myeloid lineage leucocytes like the CD14+CD16+ monocyte phenotype. Additionally in IBD, myeloid leucocytes are elevated with activation behavior, while lymphocytes are compromised. Therefore, patients' leucocytes appear logical targets of therapy. Adsorptive granulomonocytapheresis (GMA) with an Adacolumn uses carriers, which interact with the Fcγ receptor expressing leucocytes and deplete the elevated myeloid leucocytes, while the neutrophils, which re‐enter the circulation via the Adacolumn outflow (≥40%) are phagocytosed by CD19 B‐cells to become interleukin (IL)‐10 producing Bregs or CD19highCD1Dhigh B‐cells. IL‐10 is an anti‐inflammatory cytokine. GMA has been applied to treat patients with IBD. The efficacy outcomes have been impressive as well as disappointing, the clinical response to GMA defines the patients' disease course and severity at entry. Efficacy outcomes in patients with deep ulcers together with extensive loss of the mucosal tissue are not encouraging, while patients without these features respond well and attain a favorable long‐term disease course. Accordingly, for responder patients, GMA fulfills a desire to be treated without drugs.

show abstract

“…For example, it has been reported that GMA therapy was successful in a case with very severe Crohn's disease complicated by PG and cases with drug refractory neutrophilic skin lesions like PG . These reports may indicate an important role for neutrophils in PG‐like skin lesions .…”

Section: Discussionmentioning

confidence: 96%

Efficacy and Safety of Adsorptive Granulocyte and Monocyte Apheresis in Elderly and Pregnant Patients With Ulcerative Colitis

et al. 2019

View full text Add to dashboard Cite

In patients with active ulcerative colitis (UC), adsorptive granulocyte/monocyte apheresis (GMA) is expected to promote remission. We conducted a retrospective cohort study to evaluate the efficacy and safety of GMA in patients with active UC. Twenty‐one UC patients including five pregnant or lactating mothers and four elderly patients (aged >60 years) received up to 10 GMA sessions. UC severity was evaluated at baseline and after GMA therapy according to Lichtiger's Clinical Activity Index (CAI). We defined clinical remission as CAI ≤4. Overall, the median CAI score after GMA therapy had decreased from 9 to 4 (P < 0.001). The clinical remission rate was 62%, but in the elderly and pregnant or lactating mothers, the remission rates were 100% and 60%, respectively. No severe adverse effects were seen in this study. Our results may support GMA as an effective and safe treatment for active UC patients, including elderly patients and pregnant cases.

show abstract

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

Cited by 5 publications

References 35 publications

Pyoderma gangrenosum in an ulcerative colitis patient during treatment with vedolizumab responded favorably to adsorptive granulocyte and monocyte apheresis

Pyoderma gangrenosum in an ulcerative colitis patient during treatment with vedolizumab responded favorably to adsorptive granulocyte and monocyte apheresis

Granulomonocytapheresis as a cell‐dependent treatment option for patients with inflammatory bowel disease: Concepts and clinical features for better therapeutic outcomes

Efficacy and Safety of Adsorptive Granulocyte and Monocyte Apheresis in Elderly and Pregnant Patients With Ulcerative Colitis

Contact Info

Product

Resources

About