Inflammatory Bowel Disease Center, Yokkaichi Hazu Medical Center, Yokkaichi, Japan.
Center for Gastroenterology and Inflammatory Bowel Disease Research, Hamamatsu South Hospital, Hamamatsu, Japan.
Clin Transl Gastroenterol. 2018 Jul 6;9(7):170. doi: 10.1038/s41424-018-0037-0.
Adsorptive granulomonocytapheresis (GMA) with the Adacolumn has been introduced as a non-pharmacologic treatment for ulcerative colitis (UC). However, a subset of patients who might respond well to GMA needs to be targeted. This study was conducted at three IBD centers to determine factors affecting the efficacy of GMA in patients with moderately-to-severely active UC.
From January 2008 to December 2017, a total of 894 active episodes (first attack or relapse) in 593 patients were treated with GMA. Clinical remission was defined as normal stool frequency and no rectal bleeding. Multiple clinical and laboratory parameters at entry were considered for efficacy assessment.
Clinical remission was achieved during 422 (47%) of the 894 treatment cases. In the multivariate analysis, predictors for favorable response to GMA were age ≤60 years, UC duration <1 year, Mayo endoscopic subscore 2 (vs. 3), steroid naïve UC, and biologic naïve UC. Clinical remission rate was 70% in patients with four of the five factors, 52% in patients with three factors, 46% in patients with two factors, 39% in patients with one factor, and 18% in patients with none of these factors. Overall, the clinical remission rate was significantly higher in patients with a greater number of the five predictors (P < 0.0001).
GMA appeared to be effective in steroid naïve and biologic naïve patients with short duration of UC. Elderly patients (>60 years) and those with severe endoscopic activity did not respond well to GMA. Additional, well designed, prospective, controlled trials should strengthen our findings.
用 Adacolumn 进行吸附性粒状细胞分离术（GMA）已被引入作为溃疡性结肠炎（UC）的非药物治疗方法。然而，需要针对那些可能对 GMA 反应良好的亚组患者进行靶向治疗。本研究在三个 IBD 中心进行，旨在确定影响 GMA 在中重度活动期 UC 患者中的疗效的因素。
从 2008 年 1 月至 2017 年 12 月，593 名患者的 894 个活动期（首次发作或复发）接受了 GMA 治疗。临床缓解定义为正常的粪便频率和无直肠出血。在疗效评估中考虑了入组时的多个临床和实验室参数。
在 894 例治疗病例中，有 422 例（47%）达到临床缓解。在多变量分析中，GMA 反应良好的预测因素为年龄≤60 岁、UC 病程<1 年、Mayo 内镜评分 2 分（而非 3 分）、类固醇初治 UC 和生物初治 UC。在具有五个因素中的四个因素的患者中，临床缓解率为 70%；在具有三个因素的患者中，临床缓解率为 52%；在具有两个因素的患者中，临床缓解率为 46%；在具有一个因素的患者中，临床缓解率为 39%；在没有这些因素的患者中，临床缓解率为 18%。总体而言，具有较多五个预测因素的患者的临床缓解率显著更高（P<0.0001）。
GMA 似乎对 UC 病程较短且初治应用类固醇和生物制剂的患者有效。老年患者（>60 岁）和内镜活动严重的患者对 GMA 反应不佳。需要进行更多精心设计的前瞻性对照试验来加强我们的发现。
