Selective depletion of peripheral granulocyte/monocyte enhances the efficacy of scheduled maintenance infliximab in Crohn's disease.
BACKGROUND
This is the first report on a case of Crohn's disease (CD), who was successfully maintained with a combination of infliximab (IFX) and selective depletion of granulocytes/monocytes by adsorption (GMA).


METHODS
A 33-year-old female with CD activity index (CDAI) 294.2 responded to iv IFX (5mg/kg) administered at weeks 0, 2, and 6 in combination with 3000 mg/day oral 5-aminosalicylic acid (5-ASA; CDAI = 118). Then IFX at 8 week intervals was given as maintenance therapy. Two weeks before the 5th scheduled IFX, the patient worsened with an increase in stool frequency and a rise in CDAI. GMA was administered at weeks 5, 6, and 7 after her 6th iv IFX. Her CDAI decreased from 166.2 to 126.3 and 111.9 before 2nd and 3rd GMA sessions. She received her 7th iv IFX while the CDAI was 83.6. GMA course was repeated before 8th and 9th IFX. The patient remained in stable clinical and endoscopic remission without experiencing any serious side effect. After achieving mucosal healing, the patient decided to cease IFX therapy while continuing with GMA.


CONCLUSIONS
IFX appears to induce and maintain remission of CD, but it may lose its efficacy after repeated administration. GMA is safe and by selectively depleting elevated/activated leukocytes may be a useful adjunct for IFX efficacy.
Fukunaga
Ken
K
Division of Lower Gastroenterology, Hyogo College of Medicine, Hyogo 663-8501, Japan. kebe@hyo-med.ac.jp
Yokoyama
Yoko
Y
Kamikozuru
Koji
K
Yoshida
Koji
K
Kikuyama
Risa
R
Nagase
Kazuko
K
Nakamura
Shiro
S
Takei
Yoshiyuki
Y
Miwa
Hiroto
H
Matsumoto
Takayuki
T
D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003424:Crohn Disease / Q000628:therapy*; D005260:Female; D005765:Gastrointestinal Agents; D006098:Granulocytes; D006801:Humans; D000069285:Infliximab; D047589:Leukocyte Reduction Procedures / Q000379:methods*; D009000:Monocytes; D012074:Remission Induction / Q000379:methods
D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D000069285:Infliximab