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Cytapheresis.

Yoko Yokoyama, Koji Kamikozuru, Shiro Nakamura

    Nihon Rinsho. Japanese Journal of Clinical Medicine
    |December 20, 2018
    PubMed
    Summary

    Cytapheresis (CAP) therapies like LCAP and GMA show efficacy in treating inflammatory bowel disease (IBD) refractory to other treatments. Identifying patient responders early can optimize resource use and improve outcomes for ulcerative colitis and Crohn's disease.

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    Area of Science:

    • Gastroenterology
    • Immunology
    • Regenerative Medicine

    Background:

    • Inflammatory bowel disease (IBD) management includes cytapheresis (CAP) therapies such as leukocytapheresis (LCAP) and Adsorptive Granulocyte/Monocyte Apheresis (GMA) for patients refractory to conventional treatments.
    • Previous studies have not fully elucidated CAP-responder features in Crohn's disease (CD).

    Purpose of the Study:

    • To evaluate the therapeutic efficacy, safety, and demographic factors identifying responders to CAP in ulcerative colitis (UC) and Crohn's disease (CD) patients.
    • To identify factors influencing remission maintenance after GMA therapy.
    • To assess CAP efficacy in IBD patients refractory to anti-tumor necrosis factor (TNF)-α biologics.

    Main Methods:

    • Prospective multi-center studies were conducted.
    • Analysis included therapeutic efficacy, safety, and demographic data.
    • Specific patient subgroups (e.g., corticosteroid responders, high baseline activity) were analyzed for CAP response and remission maintenance.

    Main Results:

    • Demographic factors were identified that predict CAP response in ulcerative colitis (UC) patients.
    • For GMA-induced remission, shorter duration and corticosteroid responder background were significant for maintenance, while corticosteroid-dependent UC correlated with early relapse.
    • Intensive LCAP therapy proved more effective than weekly LCAP in UC patients with high baseline activity and biomarkers.
    • Efficacy of CAP in anti-TNF-α biologic-refractory IBD is under assessment.

    Conclusions:

    • Identifying patient demographic features predictive of CAP response can optimize therapeutic resource allocation and reduce patient morbidity.
    • CAP therapies offer a valuable treatment option for refractory IBD, with specific protocols showing differential efficacy based on patient characteristics.
    • Further research is ongoing to expand CAP's role in managing complex IBD cases, including those refractory to biologics.

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