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Granulocyte–monocyte apheresis: an alternative combination therapy after loss of response to anti-TNF agents in ulcerative colitis

AuthorsRodríguez-Lago, Iago; Sempere, Laura; Gutiérrez, Ana; Núñez Ortiz, Andrea; Leo Carnerero, Eduardo; Hinojosa, Esther; Mora, María; Cañete, Fiorella; Mañosa, Miriam; Herrera, Claudia; Beltrán, Belén; Forés, Ana; Arjona, Dolores; Barreiro-de Acosta, M.; Khorrami, Sam; Aguirre, Urko; Ginard, Daniel; Cabriada, José Luis
KeywordsUlcerative colitis
Anti-TNF agents
Loss of response
Granulocyte–monocyte apheresis
Issue Date2019
PublisherTaylor & Francis
CitationScandinavian Journal of Gastroenterology 54(4): 459-464 (2019)
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.
Publisher version (URL)http://dx.doi.org/10.1080/00365521.2019.1600715
Identifiersdoi: 10.1080/00365521.2019.1600715
issn: 0036-5521
e-issn: 1502-7708
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