Granulocyte–monocyte apheresis: an alternative combination therapy after loss of response to anti-TNF agents in ulcerative colitis. (3rd April 2019)

• Record Type: Journal Article
• Authors: Rodríguez–Lago, Iago; Sempere, Laura; Gutiérrez, Ana; Núñez, Andrea; Leo Carnerero, Eduardo; Hinojosa, Esther; Mora, María; Cañete, Fiorella; Mañosa, Miriam; Herrera, Claudia; Beltrán, Belén; Forés, Ana; Arjona, Dolores; Barreiro–de Acosta, Manuel; Khorrami, Sam; Aguirre, Urko; Ginard, Daniel; Cabriada, José Luis
• Is Part Of: Scandinavian journal of gastroenterology. Volume 54:Number 4(2019)
• Page Start: 459
• Page End: 464
• Publication Date: 2019-04-03
• Subjects: Ulcerative colitis -- anti-TNF agents -- loss of response -- granulocyte–monocyte apheresis; Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; 616.33
• DOI: 10.1080/00365521.2019.1600715
• Languages: English
• ISSNs: 0036-5521

Abstract

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.