title: Efficacy of high-throughput leukocytapheresis for rheumatoid arthritis with a reduced response to infliximab.
abstract: Infliximab (INF), a tumor necrosis factor-alpha (TNF-alpha) inhibitor, is an effective drug for patients with rheumatoid arthritis (RA). However, some patients receive no clinical benefit, or the agents gradually lose their effect. Five sessions of high-throughput leukocytapheresis (LCAP) were given at a frequency of once a week using a Cellsorba CS-180S to four patients with a reduced response to INF. The clinical response to LCAP was evaluated using the 28-joint disease activity score with C-reactive protein (DAS28-CRP) and with the erythrocyte sedimentation rate (DAS28-ESR). DAS28-CRP decreased significantly from 5.8 +/- 0.6 before LCAP to 3.9 +/- 0.7 (P = 0.0182) at 1-2 weeks after completion of five sessions of LCAP, and DAS28-ESR decreased significantly from 6.4 +/- 0.6 to 4.6 +/- 0.5 (P = 0.0267). Moreover, all patients had a moderate response according to the European League Against Rheumatism (EULAR) response criteria. The effect of LCAP continued for at least 6 months after its completion in all patients, with no changes in any of their concomitant drugs, and the effect was maintained for at least 1 year in three of the four patients. These results indicate that LCAP is a useful treatment for RA patients with a reduced response to INF.
authors.affiliation: Department of Internal Medicine, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan. y-sakai@nms.ac.jp
authors.forename: Yukinao
authors.initials: Y
authors.lastname: Sakai
authors.forename: Saori
authors.initials: S
authors.lastname: Sakai
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Otsuka
authors.forename: Dai
authors.initials: D
authors.lastname: Ohno
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Murasawa
authors.forename: Kazuo
authors.initials: K
authors.lastname: Munakata
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Mizuno
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000628:therapy*; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D006801:Humans; D000069285:Infliximab; D007937:Leukapheresis / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D002097:C-Reactive Protein; D000069285:Infliximab