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Multicenter Study
. 2019 Nov 21;19(1):196.
doi: 10.1186/s12876-019-1110-1.

Safety and effectiveness of granulocyte and monocyte adsorptive apheresis in patients with inflammatory bowel disease in special situations: a multicentre cohort study

Satoshi Motoya  1 , Hiroki Tanaka  2 , Tomoyoshi Shibuya  3 , Taro Osada  4 , Takayuki Yamamoto  5 , Hitoshi Hongo  6 , Chiemi Mizuno  7 , Daisuke Saito  8 , Nobuo Aoyama  9 , Toshihisa Kobayashi  10 , Hiroaki Ito  11 , Satoshi Tanida  12 , Masanori Nojima  13 , Seiichiro Kokuma  14 , Eiji Hosoi  14
Affiliations
Multicenter Study

Safety and effectiveness of granulocyte and monocyte adsorptive apheresis in patients with inflammatory bowel disease in special situations: a multicentre cohort study

Satoshi Motoya et al. BMC Gastroenterol. .

Abstract

Background: The available information on granulocyte and monocyte adsorptive apheresis (GMA) in patients with inflammatory bowel disease (IBD) under special situations remains unclear. We conducted a retrospective, multicentre cohort study to evaluate the safety and effectiveness of GMA in patients with IBD under special situations.

Methods: This study included patients with ulcerative colitis (UC) or Crohn's disease who had at least one special situation feature and who had received GMA between November 2013 and March 2017. The incidence of adverse events (AEs) was compared in relation to the special situation, and patient background factors related to an AE were identified. For patients with UC, clinical remission was defined as a partial Mayo score of ≤2.

Results: A total of 437 patients were included in this study. The incidence of AEs among the elderly patients (11.2%) was similar in all patients (11.4%), whereas the incidences of AEs in patients on multiple immunosuppressant medications (15.2%), patients with anaemia (18.1%) and paediatric/adolescent patients (18.9%) were higher than that in all patients (11.4%). In multivariate analysis, anaemia and concomitant immunosuppressant medications were independently associated with the incidence of AEs. Clinical remission was achieved in 46.4% of the patients with UC.

Conclusions: The incidence of AEs in the elderly patients was not higher than that in all patients, whereas the incidence of AE was higher in patients with anaemia and those on multiple immunosuppressant medications than that in all patients. GMA is a safe treatment option in elderly patients with IBD.

Keywords: Anaemia; Crohn’s disease; Elderly patient; GMA; Granulocyte and monocyte adsorptive apheresis; Immunosuppressant; Inflammatory bowel disease; Paediatric patient; Special situation; Ulcerative colitis.

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Conflict of interest statement

SM received consultancy fees from AbbVie G.K., Janssen Pharmaceutical K.K., Kyorin Pharmaceutical, Pfizer Japan Inc. and Takeda Pharmaceutical Co., Ltd.; lecture fees from AbbVie G.K., Janssen Pharmaceutical K.K., Mitsubishi Tanabe Pharma Corporation and Mochida Pharmaceutical Co., Ltd. and research grants from EA Pharma Co., Ltd., Janssen Pharmaceutical K.K, Takeda Pharmaceutical Co., Ltd. and Pfizer Japan Inc. HT received lecture fees from JIMRO Co., Ltd., AbbVie G.K., EA Pharma Co., Ltd., Mochida Pharmaceutical Co., Ltd., Kyorin Pharmaceutical and Mitsubishi Tanabe Pharma Corporation. TS and TO received research grants from JIMRO Co., Ltd. DS received research grants from JIMRO Co., Ltd. ST received research grants from EA Pharma Co., Ltd. MN served as a consultant for JIMRO Co., Ltd. SK and EH are personnel of JIMRO Co., Ltd.

Figures

Fig. 1
Fig. 1
Patient selection. GMA granulocyte and monocyte adsorptive apheresis, UC ulcerative colitis, CD Crohn’s disease, pMayo partial Mayo, IOIBD International Organization for the Study of Inflammatory Bowel Diseases, TNF tumour necrosis factor, CRP C-reactive protein
Fig. 2
Fig. 2
The incidences of AEs according to the number of concomitant immunosuppressant medications. AE adverse event
Fig. 3
Fig. 3
The incidences of AEs according to the type of concomitant immunosuppressant medication in patients receiving 1 concomitant medication. AE adverse event, TNF tumour necrosis factor
Fig. 4
Fig. 4
Comparison of median pMayo score at baseline and at the final assessment time in UC (a) and IOIBD score in CD (b). UC ulcerative colitis, CD Crohn’s disease, pMayo partial Mayo, IOIBD International Organization for the Study of Inflammatory Bowel Diseases
Fig. 5
Fig. 5
Clinical remission and response rates of the GMA therapy in patients with UC and CD in special situation. CD Crohn’s disease, GMA granulocyte and monocyte adsorptive apheresis, UC ulcerative colitis
Fig. 6
Fig. 6
Clinical remission and response rates of the GMA therapy in the five major special situation sub-groups of patients with UC. UC ulcerative colitis, GMA granulocyte and monocyte adsorptive apheresis
Fig. 7
Fig. 7
Comparison of median dose of corticosteroid at baseline and at the final assessment time in patients with UC (n = 103) who were on corticosteroid at baseline. UC ulcerative colitis
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