Flare up of ulcerative colitis during pregnancy treated by adsorptive granulocyte and monocyte apheresis: therapeutic outcomes in three pregnant patients

Takahashi, Hiroki; Sugawara, Kenji; Sugimura, Mikako; Iseki, Masahiro; Mano, Yutaka; Ukai, Katsuaki; Tadokoro, Keiichi

doi:10.1007/s00404-013-2748-5

Cited by 18 publications

(24 citation statements)

References 29 publications

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“…There are many cases of IBD onset in the young, which often overlaps with the time of pregnancy, and in some cases it is difficult to achieve a favorable pregnancy outcome. To our knowledge, there are a few case reports from Europe and Japan on GMA treatment in IBD patients during pregnancy or lactation period . Those reports indicated the efficacy and safety of GMA, while the number of UC patients was smaller than that of our study.…”

Section: Discussioncontrasting

confidence: 74%

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

et al. 2019

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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.

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Section: Discussioncontrasting

confidence: 74%

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

et al. 2019

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“…This means significant improvement in the quality-of-life and a decrease in the risk of side effects if these young patients had opted for an alternative drug-based therapy 16. Likewise, this nonpharmacologic treatment strategy should be promising for specific populations such as pediatric and adolescent patients with IBD,5,16 pregnant cases, fertility treatment patients,14 and patients with cytomegalovirus27 or hepatitis B virus infections 28…”

Section: Discussionmentioning

confidence: 99%

Adsorptive Granulocyte and Monocyte Apheresis in the Treatment of Ulcerative Colitis: The First Multicenter Study in China

Liu

Yao

et al. 2017

Gut and Liver

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Background/AimsPatients with active ulcerative colitis (UC) have elevated levels of activated myeloid-derived leukocytes as a source of inflammatory cytokines. The selective depletion of these leukocytes by adsorptive granulocyte/monocyte apheresis (GMA) with an Adacolumn should alleviate inflammation, promote remission and enhance drug efficacy. However, studies have reported contrasting efficacy outcomes based on patients’ baseline demographic variables. This study was undertaken to understand the demographic features of GMA responders and nonresponders.MethodsThis was a multicenter study in China involving four institutions and 34 patients with active UC. Baseline conventional medications were continued without changing the dosage. The treatment efficacy was evaluated based on the endoscopic activity index and the Mayo score.ResultsThirty of the 34 patients completed all 10 GMA treatment sessions. The overall efficacy rate was 70.59%. The receiver operating characteristic analysis showed that the area under the curve was approximately 0.766 for a Mayo score of ≤5.5 with 0.273 specificity and 0.857 sensitivity (Youden index, 0.584) for GMA responders. No GMA-related serious adverse events were observed.ConclusionsThe overall efficacy of GMA in patients with active UC who were taking first-line medications or were corticosteroid refractory was encouraging. Additionally, GMA was well tolerated and had a good safety profile.

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“…However, given that patients with IBD require life‐long medications, in children and adolescents with IBD, long‐term conventional drugs may adversely affect the patients' growth and development. Other vulnerable groups included pregnant patients . Therefore, GMA as a nondrug therapeutic intervention, if effective in these clinical settings is unrivalled by any currently known drug .…”

Section: Introductionmentioning

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

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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.

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Flare up of ulcerative colitis during pregnancy treated by adsorptive granulocyte and monocyte apheresis: therapeutic outcomes in three pregnant patients

Cited by 18 publications

References 29 publications

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

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

Adsorptive Granulocyte and Monocyte Apheresis in the Treatment of Ulcerative Colitis: The First Multicenter Study in China

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

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