Leukocyte adsorptive apheresis for the treatment of active ulcerative colitis: A prospective, uncontrolled, pilot study

Hanai, Hiroyuki; Watanabe, Fumio; Takeuchi, Ken; Iida, Takayuki; Yamada, Masami; Iwaoka, Yasushi; Saniabadi, Abby R.; Matsushita, Ikumi; Sato, Yoshihiko; Tozawa, Kotaro; Arai, Hajime; Furuta, Takahisa; Sugimoto, Ken; Bjarnason, Ingvar

doi:10.1053/jcgh.2003.50005

Cited by 189 publications

(216 citation statements)

References 42 publications

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“…The previous study reported that fiveapheresis therapy was effective for steroid naive patients, whereas it was not adequate for patients with steroid refractory long-term disease and 10 apheresis sessions were necessary for those patients. 22 The reason why GMCAP is often ineffective for longterm UC and steroid refractory UC is unknown. Recently, one study 20 found that patients with high interleukin (IL)-8 mRNA expression in the colonic mucosa were responsive to GMCAP.…”

Section: Discussionmentioning

confidence: 99%

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Granulocyte and monocyte adsorptive apheresis in the treatment of active distal ulcerative colitis: a prospective, pilot study

Yamamoto¹,

Umegae²,

Kitagawa³

et al. 2004

Aliment Pharmacol Ther

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SUMMARYAim: To assess safety and clinical efficacy of granulocyte and monocyte adsorptive apheresis for distal ulcerative colitis. Methods: Granulocyte and monocyte adsorptive apheresis therapy (five aphereses for 5 consecutive weeks) was performed for 30 consecutive patients with active distal ulcerative colitis. Patient compliance, adverse effects and clinical symptoms were regularly assessed. Results: Adverse effects were noted during nine (6%) apheresis sessions in eight patients; slight headache five, transient abdominal pain with tenesmus two, fever (38°C) one and mild liver dysfunction one. None of these adverse effects was serious and all patients could complete five aphereses. Clinical symptoms (stool frequency and consistency, rectal bleeding, tenesmus and mucus in stools) significantly improved after the third apheresis. Clinical remission (normal stool frequency and no rectal bleeding) was achieved in 21 patients (70%) after five aphereses. The median Disease Activity Index score significantly decreased; from 6 [interquartile range (IQR): 4-7] to 2 (IQR: 1-3) (P < 0.0001). Conclusion: In the treatment of active distal ulcerative colitis, granulocyte and monocyte adsorptive apheresis is safe and well-tolerated. Granulocyte and monocyte adsorptive apheresis had a beneficial effect on clinical remission and symptoms. However, randomized-controlled trials would be necessary to assess a definite efficacy of granulocyte and monocyte adsorptive apheresis.

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Section: Discussionmentioning

confidence: 99%

“…Only eight non-severe adverse effects were noted in five patients. Hanai et al 22 prospectively studied 31 patients with active corticosteroid refractory UC. They found that 81% of patients achieved clinical remission 12 weeks after the start of GMCAP and nearly 80% of the responders had maintained their remission for 12 months.…”

Section: Introductionmentioning

confidence: 99%

Granulocyte and monocyte adsorptive apheresis in the treatment of active distal ulcerative colitis: a prospective, pilot study

Yamamoto¹,

Umegae²,

Kitagawa³

et al. 2004

Aliment Pharmacol Ther

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“…Reducing granulocytes and monocytes by apheresis has the potential to reduce bowel inflammation and to improve patient status. Several controlled and uncontrolled studies have assessed the safety and efficacy of granulocyteaphaeresis (GCAP) in steroid-dependent UC [5][6][7][8] , steroid-refractory UC [9][10][11] , or as first-line therapy in naïve UC patients [12,13] . However, the optimal treatment scheme is still to be established.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of 5 versus 10 granulocyteaphaeresis sessions in steroid-dependent ulcerative colitis: A pilot, prospective, multicenter, randomized study

Ricart

Esteve²,

Andreu³

et al. 2007

WJG

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AIM:To evaluate the efficacy of 5 compared to 10 granulocyteaphaeresis sessions in patients with active steroid-dependent ulcerative colitis. METHODS:In this pilot, prospective, multicenter randomized trial, 20 patients with moderately active steroid-dependent ulcerative colitis were randomized to 5 or 10 granulocyteaphaeresis sessions. The primary objective was clinical remission at wk 17. Secondary measures included endoscopic remission and steroid consumption.RESULTS: N i n e p a t i e n t s w e r e r a n d o m i z e d t o 5 granulocyteaphaeresis sessions (group 1) and 11 patients to 10 granulocyteaphaeresis sessions (group 2). At wk 17, 37.5% of patients in group 1 and 45.45% of patients in group 2 were in clinical remission. Clinical remission was accompanied by endoscopic remission in all cases. Eighty-six percent of patients achieving remission were steroid-free at wk 17. Daily steroid requirements were significantly lower in group 2. Eighty-nine per cent of patients remained in remission during a one year followup. One serious adverse event, not related to the study therapy, was reported. CONCLUSION:Granulocyteaphaeresis is safe and effective for the treatment of steroid-dependent ulcerative colitis. In this population, increasing the number of aphaeresis sessions is not associated with higher remission rates, but affords a significant steroid-sparing effect.

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“…24 Further, in patients with active IBD, peripheral blood granulocytes and monocytes/macrophages are elevated, show activation behavior and increased survival time. 11,[25][26][27][28][29] As these leukocytes are major sources of inflammatory cytokines, 30,31 they are suspected to contribute to the exacerbation and perpetuation of IBD. 32,33 In this study, we looked at the demographic background of the enrolled patients and found that those who had responded to CAP had significantly lower levels of serum CRP, CAI and the dose of iv PSL at entry.…”

Section: Discussionmentioning

confidence: 99%

Cytapheresis in Patients with Severe Ulcerative Colitis after Failure of Intravenous Corticosteroid: A Long-Term Retrospective Cohort Study

Fukunaga

Nagase²,

Kusaka³

et al. 2009

Gut Liver

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Background/Aims: Cytapheresis (CAP) is a novel strategy for ulcerative colitis (UC). However, there is insufficient data on the long-term outcome of UC patients who achieve remission by CAP. This study involved patients with severe UC who refracted to intravenous (iv) corticosteroid. Methods: Forty-seven UC patients who had received CAP therapy for the first time within 1 year after UC diagnosis were followed for 36 months. One of the inclusion criteria was a clinical activity index (CAI) of ≥7 points at the end of a 2-week iv course of corticosteroid therapy. CAP therapy consisted of ten sessions over 10 weeks. Results: CAP induced clinical remission (CAI≤4) in 70.2% patients (33/47). The number of submissions for colectomy was higher for severe UC at entry (CAI≥12, n=25) than for moderately severe UC at entry (7≤CAI ＜12, p=15; p＜0.02). The cumulative rates of avoiding surgery and relapse were 54.5% and 24.2%, respectively, at 36 months in patients who responded to CAP therapy. This was similar to that of iv cyclosporine reported recently. Conclusions: This study suggest that CAP is an effective therapy in patients who are refractory to conventional medications including iv corticosteroid. Increased remission rates should be expected in refractory patients with moderately severe UC. (Gut and Liver 2009;3:41-47)

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Leukocyte adsorptive apheresis for the treatment of active ulcerative colitis: A prospective, uncontrolled, pilot study

Cited by 189 publications

References 42 publications

Granulocyte and monocyte adsorptive apheresis in the treatment of active distal ulcerative colitis: a prospective, pilot study

Granulocyte and monocyte adsorptive apheresis in the treatment of active distal ulcerative colitis: a prospective, pilot study

Evaluation of 5 versus 10 granulocyteaphaeresis sessions in steroid-dependent ulcerative colitis: A pilot, prospective, multicenter, randomized study

Cytapheresis in Patients with Severe Ulcerative Colitis after Failure of Intravenous Corticosteroid: A Long-Term Retrospective Cohort Study

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