Efficacy of cytapheresis in patients with ulcerative colitis showing insufficient or lost response to biologic therapy

Abstract

For the optimal management of refractory ulcerative colitis (UC), secondary loss of response (LOR) and primary non-response to biologics is a critical issue. This article aimed to summarize the current literature on the use of cytapheresis (CAP) in patients with UC showing a poor response or LOR to biologics and discuss its advantages and limitations. Further, we summarized the efficacy of CAP in patients with UC showing insufficient response to thiopurines or immunomodulators (IM). Eight studies evaluated the efficacy of CAP in patients with UC with inadequate responses to thiopurines or IM. There were no significant differences in the rate of remission and steroid-free remission between patients exposed or not exposed to thiopurines or IM. Three studies evaluated the efficacy of CAP in patients with UC showing an insufficient response to biologic therapies. Mean remission rates of biologics exposed or unexposed patients were 29.4 % and 44.2%, respectively. Fourteen studies evaluated the efficacy of CAP in combination with biologics in patients with inflammatory bowel disease showing a poor response or LOR to biologics. The rates of remission/response and steroid-free remission in patients with UC ranged 32%-69% (mean: 48.0%, median: 42.9%) and 9%-75% (mean: 40.7%, median: 38%), respectively. CAP had the same effectiveness for remission induction with or without prior failure on thiopurines or IM but showed little benefit in patients with UC refractory to biologics. Although heterogeneity existed in the efficacy of the combination therapy with CAP and biologics, these combination therapies induced clinical remission/response and steroid-free remission in more than 40% of patients with UC refractory to biologics on average. Given the excellent safety profile of CAP, this combination therapy can be an alternative therapeutic strategy for UC refractory to biologics. Extensive prospective studies are needed to understand the efficacy of combination therapy with CAP and biologics.

Adsorptive cytapheresis in ulcerative colitis: A non‐pharmacological therapeutic approach revisited

“…This could be anticipated, considering the reduced migration of leucocytes in the inflamed areas resulting from adsorptive cytapheresis. The response to GMA in relation to the use of immunomodulators (IM) or biologics has been recently summarized by Iitzuka, 46 showing that previous exposure to biologics, but not to IM, reduces the efficacy of AC from 44.2% to 29.4%. These results are nonetheless good, considering that AC was used as second‐ or third‐line therapy in a particularly problematic subset of patients.…”

“…Overall, the safety profile of AC proved better than that of any other drug used for treating UC patients, including steroids, immunomodulators, and biologics 2,46,62,64,65 …”

IBD barriers across the continents – East Asia

“…71,72 Based on the primary goal of CAP to deplete effector cells of the intestinal inflammatory response, this non-pharmacological extracorporeal therapy has been gaining evidence in its efficacy in UC treatment with excellent safety profile. 72–74…”

“…71,72 Based on the primary goal of CAP to deplete effector cells of the intestinal inflammatory response, this non-pharmacological extracorporeal therapy has been gaining evidence in its efficacy in UC treatment with excellent safety profile. [72][73][74] Recently, the AOCC and APAGE practice have jointly published a consensus on medical management and monitoring for IBD in Asia as well. 61 With the development on more structured recommendations, these have shed lights on management targeting the Asia IBD patients.…”

MicroRNA and granulocyte‐monocyte adsorption apheresis combotherapy after inadequate response to anti‐TNF agents in ulcerative colitis

“…11 In fact, the combination of GMA with antitumor necrosis factor alpha therapy (antiTNF-α) resulted in reduced clinical activity, and loss of response to infliximab can be recovered after adding GMA in a combo therapy. 9,12 Despite all the advances in characterizing the epigenetics in IBD and in response to current treatment, nothing is known about the role of microRNAs in GMA therapy in UC. Therefore, we aimed here to study the microRNA profiles associated with GMA treatment, in combination therapy with infliximab, analyzing their changes and identifying potential microRNAs associated with GMA therapeutic response.…”