Extracorporeal photopheresis for the treatment of refractory Crohnʼs disease: Results of an open-label pilot study

Abreu, María T.; Tirpitz, Christian von; Hardi, Robert; Kaatz, Martin; Assche, Gert Van; Rutgeerts, Paul; Bisaccia, Emil; Goerdt, S; Hanauer, Stephen B.; Knobler, Robert; Mannon, Peter J.; Mayer, Lloyd; Ochsenkühn, Thomas; Sandborn, William J.; Parenti, Dennis; Lee, Kevin; Reinisch, Walter

doi:10.1002/ibd.20833

Cited by 40 publications

(33 citation statements)

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“…dependent disease [48,49]. In a recent multicenter study including 28 patients with moderate to severe CD refractory to immunomodulators and/or TNF-antagonists, ECP treatment achieved a marked reduction in CD activity: 50% of patients responded and 25% were in remission [50]. …”

Section: Disclosure Statementmentioning

confidence: 99%

Clinical Results of Extracorporeal Photopheresis

Worel

Leitner²

2012

Transfus Med Hemother

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Extracorporeal photopheresis (ECP) is a combination of leukapheresis and photodynamic therapy in which blood is treated with photoactivable drugs which are then activated with ultraviolet light and re-infused to the patient. It has been used successfully for more than 30 years in the treatment of erythrodermic cutaneous T-cell lymphoma (CTCL) and over 20 years for chronic graft-versus-host disease (GVHD). ECP has also shown promising results in the treatment of acute GVHD and other T-cellmediated diseases, including systemic sclerosis, treatment and prevention of solid organ rejection, and more recently Crohn’s disease. The use of ECP may allow a significant reduction or even discontinuation of corticosteroids and/or other immunosuppressants, thus leading to reduced long-term morbidity and mortality and improved overall survival. ECP is a well-tolerated therapy. No significant side effects have been reported during the last 30 years. It has been shown that ECP is not associated with an increased incidence of infections, malignancies, or recurrence of underlying malignant disease, neither during short-term nor during long-term therapy.

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Section: Disclosure Statementmentioning

confidence: 99%

Clinical Results of Extracorporeal Photopheresis

Worel

Leitner²

2012

Transfus Med Hemother

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“…Two uncontrolled case series have been published suggesting that extracorporealphotopheresis (ECP) can promote remission for a proportion of patients in the category of steroid and/or immunosuppressant intolerant or refractory CD [165,166] . The domain of ECP is Tcell mediated diseases, like Tcell lymphoma or acute or chronic graft vs host disease (GvHD).…”

Section: Extracorporealphotopheresismentioning

confidence: 99%

“…IL10, also known as cytokinesynthesis inhibitory factor, is a potent anti-inflammatory cytokine [171] . Abreu et al [165] observed in 28 patients with moderatetoseverely active CD (mean baseline CDAI 324) who were refractory to or intolerant of immunosuppressants and/ or antiTNF agents that ECP was well tolerated and induced clinical response (50%) and remission (25%) in patients with CD [165] . Reinisch confirmed these results in 31 CD patients, ECP permitted reduction or discontinuation in steroid dependent or refractory patients [166] .…”

Section: Extracorporealphotopheresismentioning

confidence: 99%

Pharmacological- and non-pharmacological therapeutic approaches in inflammatory bowel disease in adults

Leitner

Vogelsang

2016

WJGPT

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Inflammatory bowel diseases (IBDs) are a group of chronic inflammatory conditions mainly of the colon and small intestine. Crohn's disease (CD) and ulcerative colitis (UC) are the most frequent types of IBD. IBD is a complex disease which arises as a result of the interaction of environmental, genetic and immunological factors. It is increasingly thought that alterations of immunological reactions of the patients to their own enterable bacteria (microfilm) may contribute to inflammation. It is characterized by mucosal and sub mucosal inflammation, perpetuated by infiltration of activated leukocytes. CD may affect the whole gastrointestinal tract while UC only attacks the large intestine. The therapeutic goal is to achieve a steroidfree long lasting remission in both entities. UC has the possibility to be cured by a total colectomy, while CD never can be cured by any operation. A lifelong intake of drugs is mostly necessary and essential. Medical treatment of IBD has to be individualized to each patient and usually starts with anti-inflammatory drugs. The choice what kind of drugs and what route administered (oral, rectal, intravenous) depends on factors including the type, the localization, and severity of the patient's disease. IBD may require immune-suppression to control symptoms such as prednisolone, thiopurines, calcineurin or sometimes folic acid inhibitors or biologics like TNF-α inhibitors or anti-integrin antibodies. For both types of disease (CD, UC) the same drugs are available but they differ in their preference in efficacy between CD and UC as 5-aminosalicylic acid for UC or budesonide for ileocecal CD. As therapeutic alternative the main mediators of the disease, namely the activated pro-inflammatory cytokine producing leukocytes can be selectively removed via two apheresis systems (Adacolumn and Cellsorba) in steroid-refractory or dependent cases. Extracorporeal photopheresis results in an increase of regulatory B cells, regulatory CD8 + T cells and T-regs Type 1. Both types of apheresis were able to induce clinical remission and mucosal healing accompanied by tapering of steroids.

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“…Mean C-reactive protein (CRP) declined and intestinal permeability in patients with ileal and ileocolonic Crohn's disease decreased after ECP. Recently, a phase II study investigating ECP in 28 patients with moderately active CD who were refractory or intolerant to immunosuppressants and/or anti-TNF agents was completed (112). ECP was performed twice weekly for 4 weeks then twice weekly every other week until week 12.…”

Section: Ecp Therapy In Crohn's Diseasementioning

confidence: 99%