Single‐Needle Intensive Granulocyte and Monocyte Adsorptive Apheresis Is Suitable for Elderly Patients With Active Ulcerative Colitis Taking no Corticosteroids or Biologics

Abstract

Twice‐weekly intensive granulocyte/monocyte adsorptive apheresis is effective and safe for ulcerative colitis, but maintaining two blood access routes is problematic. We previously reported that intensive granulocyte/monocyte adsorptive apheresis using a single needle in ulcerative colitis is effective and safe. We hypothesized that the efficacy and safety of single‐needle intensive granulocyte/monocyte adsorptive apheresis for ulcerative colitis would especially benefit the elderly. We enrolled 17 elderly ulcerative colitis patients to receive single‐needle intensive granulocyte/monocyte adsorptive apheresis, 27 elderly ulcerative colitis patients to receive double‐needle intensive granulocyte/monocyte adsorptive apheresis, and 52 nonelderly ulcerative colitis patients to receive single‐needle intensive granulocyte/monocyte adsorptive apheresis. Remission and mucosal healing rates after treatment did not differ significantly between elderly ulcerative colitis patients receiving single‐needle apheresis and the other two groups. In addition, no serious adverse effects, including blood clots, were observed in single‐needle intensive granulocyte/monocyte adsorptive apheresis patients. Single‐needle intensive granulocyte/monocyte adsorptive apheresis might be a novel alternative therapeutic option for elderly ulcerative colitis patients before considering corticosteroids.

Induction of mucosal healing by intensive granulocyte/monocyte adsorptive apheresis (GMA) without use of corticosteroids in patients with ulcerative colitis: long-term remission maintenance after induction by GMA and efficacy of GMA re-treatment upon relapse

“…(30,31) Our group previously reported that intensive GMA without use of CS induced clinical remission in 70-80% of active UC patients as well as endoscopic remission (MH) in 60-70% of those. (32,35,36) Of the present patients who underwent first GMA, 70.6% (84/119) achieved clinical remission and MH (Fig. 1).…”

“…In contrast, intensive GMA is a temporary therapy that has sufficient effects for inducing clinical and endoscopic remission, and its greatest advantage is that treatment can be safely performed without serious adverse events. (29,32,35,36) This study has several limitations, including its retrospective nature. Furthermore, cases from only two hospitals were used for analysis.…”

“…Intensive GMA was performed without use of CS for UC patients as previously described. ( 29 , 32 , 35 , 36 ) Blood access was gained through the antecubital vein in one arm, while the return to the patient was through the antecubital vein in the contralateral or same arm, both through a 19-gauge needle. GMA was performed at a flow rate of 30 ml/min for 60 min, with the aim to expose 1,800 ml of blood per session (one session).…”

“…Disease relapse was diagnosed when a CAI score of >7 points was confirmed despite receiving the maximum dose of 5-ASA or adjusted dose of thiopurine. (35)(36)(37) The cumulative non-relapse rate was calculated at weeks 26, 52, 104, and 156 after achieving clinical remission and MH by first GMA. Various clinical parameters were then compared between relapsed and non-relapsed patients in order to determine relapseassociated factors.…”

Intensive granulocyte and monocyte adsorption apheresis for generalized pustular psoriasis

“…1 Securing the two stable vascular access routes through the antecubital veins is sometimes difficult, particularly in elderly patients. Although single-needle intensive GMA has recently been reported in elderly patients with ulcerative colitis, 15 it has not been generally available. Thus, intensive GMA is applicable for cases with difficulty in securing peripheral vessels as well as for cases during pregnancy.…”