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[Granulocyte and monocyte adsorption apheresis in Korean conventional treatment-refractory patients with active
Hyo Jong Kim1, Joo Sung Kim, Dong Soo Han
1Departments of Internal Medicine, Kyunghee University College of Medicine, Seoul, Korea.
Insights
Granulocyte and monocyte adsorption apheresis safely improved ulcerative colitis (UC) symptoms and quality of life in patients refractory to standard treatments. This therapy offers a promising option for managing moderate-to-severe active UC.
Area of Science:
- Gastroenterology
- Immunology
- Medical Technology
Background:
- Ulcerative colitis (UC) involves granulocyte and monocyte migration into the colonic mucosa, perpetuating inflammation.
- Patients with moderate-to-severe UC often exhibit refractoriness to conventional therapies.
Purpose of the Study:
- To evaluate the safety and efficacy of granulocyte and monocyte adsorption apheresis in UC patients.
- To assess the impact of this therapy on clinical disease activity, inflammatory markers, and quality of life.
Main Methods:
- An open-label trial involving 27 patients with moderate-to-severe active UC.
- Patients underwent five 60-minute apheresis sessions using an Adacolumn over 5 weeks.
- Efficacy was measured by clinical disease activity, SIBDQ, CRP, and endoscopic scores at week 7.
Main Results:
- 70.4% of patients demonstrated overall improvement at 7 weeks.
- Significant improvements were observed in clinical disease activity (p < 0.0001), endoscopic scores (p < 0.001), and quality of life (SIBDQ, p < 0.0001).
- Steroid tapering or discontinuation was possible in 56.3% of patients on concomitant steroids; treatment was well-tolerated with no severe adverse events.
Conclusions:
- Adacolumn apheresis is highly efficacious for moderate-to-severe active UC patients unresponsive to conventional therapy.
- The treatment is safe and well-tolerated.
- Further investigation is warranted to fully assess the long-term benefits.
Background/Aims:
In chronic inflammatory conditions such as ulcerative colitis (UC), the migration of granulocytes and monocytes/macrophages from the circulation into the colonic mucosa is especially important in maintaining inflammation. The aim of this trial was to assess safety and efficacy of granulocyte and monocyte adsorption apheresis in patients with moderate-to-severe UC refractory to conventional drug therapies.
Methods:
Twenty-seven patients with moderate (55.6%) to severe (44.4%) active UC refractory to conventional drug therapies who had no changes in their conventional therapy regimen in the past two weeks before the recruitment were enrolled in an open-label trial. Concomitant medications were allowed, and steroids were tapered down according to the clinical activity during the course. We used an adsorptive type extracorporeal column (Adacolumn; JIMRO, Takasaki, Japan), which selectively adsorb granulocytes and monocytes. Patients took five apheresis sessions, each with 60 minutes duration for 5 consecutive weeks. The primary efficacy variables were clinical disease activity, short inflammatory bowel disease questionnaire (SIBDQ), C-reactive protein (CRP), and endoscopic scores. These variables were scored at regular intervals, and analyzed at week 7 on an intention-to-treat (ITT) principles.
Results:
At 7 weeks, 70.4% of patients showed overall improvement. Clinical disease activity (p < 0.0001), endoscopic score (p < 0.001), and the quality of life as assessed by SIBDQ (p < 0.0001) were significantly improved after the therapy. In 56.3% of concomitant steroid users, tapering down or discontinuation of steroids was possible. Treatment was well tolerated, and no severe adverse events were observed.
Conclusions:
Adacolumn was very efficacious in patients with moderate-to-severe active UC refractory to conventional drug therapy, but further assessment is needed.
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