Efficacy of granulocyte and monocyte apheresis for antibiotic-refractory pouchitis after proctocolectomy for ulcerative colitis: an open-label, prospective, multicentre study

Abstract

Background:Granulocyte and monocyte apheresis (GMA) has shown therapeutic efficacy in active ulcerative colitis (UC). We thought that in patients with pouchitis after proctocolectomy for UC, GMA might produce immunological effects in the intestinal mucosa, and improve clinical symptoms. This prospective study was to evaluate the efficacy of GMA for antibiotic-refractory pouchitis after proctocolectomy for UC.Methods:A total of 13 patients with pouchitis disease activity index (PDAI) > 7 unresponsive to 2 weeks of antibiotic therapy were included. All patients received 10 GMA sessions at 2 sessions/week over 5 consecutive weeks. The primary endpoints were response (a decrease of ⩾3 points in the PDAI) and remission (PDAI < 4). Secondary endpoints included reduction of white blood cells (WBCs), C-reactive protein (CRP), faecal markers (calprotectin and lactoferrin), reduction of the PDAI endoscopic subscore, and GMA safety.Results:The median PDAI score was significantly decreased from 11 (range, 9–15) at entry to 9 (range, 6–13) after the GMA therapy (p = 0.02). A total of six patients (46%) responded to the treatment, but none achieved remission. The median endoscopic subscore (maximum: 6) was 5 (range, 4–6) at entry and 5 (range, 1–6) after the treatment (p = 0.10). None of the laboratory markers (WBCs, CRP, faecal calprotectin and lactoferrin) significantly changed during the treatment. Transient adverse events (AEs) were observed in two patients (15%), dyspnoea in one and headache in one. The AEs were not serious, and all patients completed the 10 GMA sessions.Conclusions:GMA has a good safety profile, but its efficacy appears to be limited in the management of chronic refractory pouchitis. However, a large controlled study should be conducted to evaluate the efficacy of GMA therapy in patients with pouchitis at an earlier clinical stage, before the disease has become refractory to conventional medical therapy.

Vedolizumab for chronic antibiotic-refractory pouchitis

“…Therefore, relying only on clinical symptoms is not the best way to monitor response in these patients and should be confirmed by pouchoscopy with biopsy [3]. Besides vedolizumab, various other therapies have been tried for CARP including granulocyte and monocyte aphresis [17], green tea polyphenol epigallocatechin gallate (EGCG) [18] and Alicaforsen, an intercellular adhesion molecule-1 (ICAM-1) antisense oligonucleotide [19, 20], but data are limited regarding their long-term efficacy and safety. In our study, only two (11%) patients had adverse events; exacerbation of EIM was seen in three (16%), with exacerbation of rheumatic manifestation being the most common.…”

Granulocyte and monocyte/macrophage apheresis for the treatment of immune-mediated inflammatory arthropathies: case reports

“…However, it would be interesting to assess the evolution of inflammatory and biological markers after GMA sessions as it has been studied in patients with UC treated with GMA. 41 , 42 Finally, in case 4, GMA was used as a temporary treatment to also solve extra-articular manifestations related to the inflammatory condition. The patient had had repeated infections and gum healing problems.…”

Chronic Antibiotic-Refractory Pouchitis: Management Challenges

“…[95][96][97][98][99] An open-label prospective study was done by Yamamoto et al to evaluate the efficacy of granulocyte and monocyte apheresis for chronic antibiotic-refractory pouchitis. 100 Thirteen patients were included and received 10 GMA sessions at 2 sessions/week over five consecutive weeks. Six patients responded to the treatment (reduction of PDAI with ≥ 3 points) but none achieved remission (PDAI < 4).…”