Iago Rodríguez-Lago1, Laura Sempere2, Ana Gutiérrez2,3, Andrea Núñez4, Eduardo Leo Carnerero4, Esther Hinojosa5, María Mora5, Fiorella Cañete6, Miriam Mañosa6, Claudia Herrera7, Belén Beltrán8, Ana Forés9, Dolores Arjona10, Manuel Barreiro-de Acosta11, Sam Khorrami12, Urko Aguirre13, Daniel Ginard12, José Luis Cabriada1. 1. a Gastroenterology Department , Hospital de Galdakao , Galdakao , Spain. 2. b Gastroenterology Department , Hospital General Universitario de Alicante , Alicante , Spain. 3. c CIBEREHD (Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas) , Madrid, Spain. 4. d Gastroenterology Department , Hospital Universitario Virgen del Rocío , Sevilla , Spain. 5. e Gastroenterology Department , Hospital de Manises , Manises , Spain. 6. f Gastroenterology Department , Hospital Universitari German Trias i Pujol , Badalona , Spain. 7. g Gastroenterology Department , Hospital Universitario de Vall d'Hebron , Barcelona , Spain. 8. h Gastroenterology Department , Hospital Universitari i Politècnic La Fe , Valencia , Spain. 9. i Gastroenterology Department , Hospital General Universitario de Castellón , Castellón , Spain. 10. j Gastroenterology Department , Hospital General Universitario de Elche , Elche , Spain. 11. k Gastroenterology Department , Hospital Clínico Universitario de Santiago de Compostela , Santiago de Compostela , Spain. 12. l Gastroenterology Department , Hospital Universitario Son Espases , Palma , Spain. 13. m Research Unit, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Hospital de Galdakao , Galdakao , Spain.
Abstract
Objective: To evaluate the effectiveness and safety of the combination of granulocyte-monocyte apheresis (GMA) after loss of response (LOR) to anti-tumor necrosis factor (TNF) agents in ulcerative colitis (UC). Materials and methods: A retrospective, multicenter study was performed in 11 inflammatory bowel disease (IBD) Units. Clinical remission was defined as a partial Mayo score ≤2. The effectiveness of the treatment was evaluated by the partial Mayo score and the rate of anti-TNF intensification, switch, swap or colectomy. Results: Forty-seven patients with ulcerative colitis were included (mean age 35 years, mean disease duration 52 months, 66% male and 59% extensive colitis). Twenty-three subjects were receiving infliximab, eighteen adalimumab and six golimumab. GMA was combined after a primary non-response (49%) or secondary loss of response (51%) to anti-TNF therapy. We observed a significant decrease in partial Mayo score and fecal calprotectin after GMA. Fifteen patients (32%) responded to the combination therapy without anti-TNF intensification, switch, swap or colectomy. Eight patients (17%) underwent colectomy. Two patients (4%) presented adverse events related to the technique. Conclusions: Combination of GMA and anti-tumor necrosis factor is a safe and effective treatment after the loss of response to these biologic agents, with a significant decrease of the clinical disease activity and biomarkers, in a population with limited therapeutic alternatives.
Objective: To evaluate the effectiveness and safety of the combination of granulocyte-monocyte apheresis (GMA) after loss of response (LOR) to anti-tumor necrosis factor (TNF) agents in ulcerative colitis (UC). Materials and methods: A retrospective, multicenter study was performed in 11 inflammatory bowel disease (IBD) Units. Clinical remission was defined as a partial Mayo score ≤2. The effectiveness of the treatment was evaluated by the partial Mayo score and the rate of anti-TNF intensification, switch, swap or colectomy. Results: Forty-seven patients with ulcerative colitis were included (mean age 35 years, mean disease duration 52 months, 66% male and 59% extensive colitis). Twenty-three subjects were receiving infliximab, eighteen adalimumab and six golimumab. GMA was combined after a primary non-response (49%) or secondary loss of response (51%) to anti-TNF therapy. We observed a significant decrease in partial Mayo score and fecal calprotectin after GMA. Fifteen patients (32%) responded to the combination therapy without anti-TNF intensification, switch, swap or colectomy. Eight patients (17%) underwent colectomy. Two patients (4%) presented adverse events related to the technique. Conclusions: Combination of GMA and anti-tumor necrosis factor is a safe and effective treatment after the loss of response to these biologic agents, with a significant decrease of the clinical disease activity and biomarkers, in a population with limited therapeutic alternatives.
Entities:
Keywords:
Ulcerative colitis; anti-TNF agents; granulocyte–monocyte apheresis; loss of response