Combination Therapy With Adalimumab Plus Intensive Granulocyte and Monocyte Adsorptive Apheresis in Patients With Refractory Ulcerative Colitis.
BACKGROUND
The efficacy and safety of combination therapy with adalimumab (ADA) plus intensive granulocyte and monocyte adsorptive apheresis (GMA) (two sessions per week) for the treatment of refractory ulcerative colitis (UC) have not been previously evaluated.


METHODS
This retrospective study evaluated the 10-week efficacy of combination therapy with ADA plus intensive GMA on refractory UC patients, on clinical outcomes over 52 weeks under subsequent maintenance monotherapy of ADA, and the effect of combined azathioprine (AZA) with ADA at failure to achieve clinical remission at 10 weeks and at flare-up by 52 weeks. Ten patients were given initial combination therapy of ADA (160/80/40 mg every other week) plus intensive GMA. One patient received total colectomy because of poor response.


RESULTS
Of nine patients who received this combination therapy, 55.6% displayed cumulative clinical remission at 10 weeks and 33.3% displayed such remission at 52 weeks under subsequent maintenance monotherapy of ADA. The percentage of patients with mucosal healing at 10 weeks (endoscopy subscore ≤ 1) was 66.7%. Adverse events were observed in three patients (pneumonia, cerebral infarction and headache).


CONCLUSIONS
It was concluded that combination therapy with ADA plus intensive GMA is useful for induction of clinical remission in refractory UC patients, and is well tolerated.
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya City Aichi Prefecture, Japan.
Satoshi
S
Tanida
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya City Aichi Prefecture, Japan.
Tsutomu
T
Mizoshita
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya City Aichi Prefecture, Japan.
Hirotada
H
Nishie
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya City Aichi Prefecture, Japan.
Keiji
K
Ozeki
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya City Aichi Prefecture, Japan.
Takahito
T
Katano
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya City Aichi Prefecture, Japan.
Eiji
E
Kubota
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya City Aichi Prefecture, Japan.
Hiromi
H
Kataoka
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya City Aichi Prefecture, Japan.
Takeshi
T
Kamiya
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya City Aichi Prefecture, Japan.
Takashi
T
Joh
Clinical remission; Long-term efficacy; Mucosal healing; Ulcerative colitis