Granulocyte‐Monocyte Apheresis as an Adjuvant Therapy to Anti‐Tumor Necrosis Factor Drugs for Ulcerative Colitis

Abstract

Biologic anti-tumor necrosis factor (TNF) drugs have demonstrated their efficacy for the treatment of ulcerative colitis. Nevertheless, some patients will not respond to this therapy or will develop loss of response. Leukapheresis is the main non-pharmacological therapy for some immune-mediated diseases. The aim of our study was to describe our experience with this therapy in ulcerative colitis patients after loss of response to anti-TNF treatment. Leukapheresis was indicated in four patients with left-sided or extensive colitis because of partial response to biological therapy or secondary loss of response to it. All patients received 8 to 10 sessions in an intensive regimen. Globally, a decrease in the Mayo score was observed. The overall response rate was 50% with one patient who displayed sustained response. No patients have required colectomy during follow-up. Adjuvant treatment with leukapheresis in patients with inadequate response to anti-TNF treatment showed some beneficial effect, although of limited duration, in patients with ulcerative colitis.

The combination of granulocyte‐monocyte apheresis and vedolizumab: A new treatment option for ulcerative colitis?

“…The potential combination of GMA with anti-TNF agents has also been reported recently. 7,16 In our experience, after a primary nonresponse (59%) or secondary loss of response (51%), approximately one-third of these patients responded to the combination therapy without further anti-TNF intensification, switch, swap or colectomy after a follow-up of 9 months. The combination with anti-integrin monoclonal antibodies has also been described as a promising therapy in UC.…”

“…To date, many different drugs have been successfully combined with VDZ, namely tofacitinib, infliximab, certolizumab pegol, golimumab, ustekinumab, etanercept, and calcineurin inhibitors. The potential combination of GMA with anti‐TNF agents has also been reported recently . In our experience, after a primary nonresponse (59%) or secondary loss of response (51%), approximately one‐third of these patients responded to the combination therapy without further anti‐TNF intensification, switch, swap or colectomy after a follow‐up of 9 months.…”