Therapeutic depletion of myeloid lineage leukocytes by adsorptive apheresis for psoriatic arthritis: Efficacy of a non‐drug intervention for patients refractory to pharmacologics

Abstract

Psoriatic arthritis (PsA), a chronic inflammatory arthropathy associated with psoriasis, is an intractable immune disorder and refractory to pharmacological intervention. We assessed efficacy of selective depletion of myeloid lineage leukocytes in patients with PsA in a multicenter setting. A total of 20 patients with moderate to severe PsA refractory to conventional and biological disease-modifying antirheumatic drugs were included. Eligible patients had 3 points or more in the classification criteria for PsA. Each patient received five sessions, once a week, of adsorptive granulocyte and monocyte apheresis (GMA) with the Adacolumn . The primary efficacy outcome was 20% or more decrease in the American College of Rheumatology score 20 (ACR20). Partial responders could receive an additional five GMA sessions. Of 20 patients, two did not complete the study, nine responded to five GMA sessions and nine received 10 sessions. At the first evaluation 2 weeks after the last GMA session, 13 of the 20 (65.0%) patients achieved ACR20. ACR20 was maintained in seven of 10 (70%) and five of 10 (50%) patients at the follow-up evaluation points 8 and 20 weeks after the last GMA session, respectively. GMA was well tolerated without any safety concern. This study demonstrates that GMA with the Adacolumn was effective with good safety profile in patients with PsA refractory to pharmacologicals. The results indicate a major role for myeloid leukocytes in the immunopathogenesis of PsA. A large controlled study is warranted to fully evaluate the efficacy of Adacolumn GMA in patients with PsA.

Successful treatment of plaque‐type psoriasis by granulocyte and monocyte adsorption apheresis in a patient with psoriatic arthritis

“…Our patient's arthritis and plaque-type psoriatic lesions responded well to GMA treatment although our and earlier studies [1][2][3][4] suggested that plaque-type psoriasis is less sensitive to GMA. T-helper (Th)17 cells play a pivotal role in the development of plaque-type psoriasis, 5 while PP and PsA are mediated chiefly by Th1 cells; they activate neutrophils and macrophages that are selectively removed by GMA.…”

“…A multicenter study demonstrated the beneficial effects of GMA for PsA. 4 There was a discrepancy in effectiveness of GMA on arthropathy and skin lesions. Twenty percent improvement in American College of Rheumatology score (ACR20) was obtained in 13 of 20 enrolled patients.…”

Pyoderma gangrenosum in an ulcerative colitis patient during treatment with vedolizumab responded favorably to adsorptive granulocyte and monocyte apheresis

“…12,13 Regarding GMA, it was initially approved as induction therapy for active UC, 14 and subsequently was found to be effective for CD, pustular psoriasis, and psoriatic arthritis. [15][16][17] Additionally, GMA has been reported to be effective for various skin conditions such as PG and systemic lupus erythematosus. [18][19][20] Moreover, there have been reports that the combination of cytapheresis and prednisolone improved PG associated with IBD.…”

Clinical and immunological effects of adsorptive myeloid lineage leukocyte apheresis in patients with immune disorders

“…GMA was well tolerated without any safety concern. This study demonstrated that GMA was effective with good safety profile in patients with PsA refractory to pharmacologicals …”

“…Psoriatic arthritis treatment outcomes. Changes in the tender joint count ( TJC ), swollen joint count ( SJC ), physician's health assessment score as visual analog scale ( VAS ), patient's pain assessment score ( VAS ), patient's health assessment score ( VAS ), health assessment questionnaire ( HAQ ) and C‐reactive protein ( CRP ) (cited from reference ). BL , baseline; EV , evaluation time point.…”