Tanida Satoshi, Ozeki Keiji, Katano Takahito, Tanaka Mamoru, Shimura Takaya, Kubota Eiji, Kataoka Hiromi, Takahama Takuya, Sasoh Shun, Kubota Yoshimasa, Ban Tesshin, Ando Tomoaki, Nakamura Makoto, Joh Takashi
Education and Research Center for Community Medicine, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan.
Division of Gastroenterology, Gamagori City Hospital, Hirata, Gamagori, Aichi 443-8501, Japan.
J Clin Med Res. 2023 Mar;15(3):181-186. doi: 10.14740/jocmr4887. Epub 2023 Mar 28.
Every-week (ew) adalimumab (ADA) maintenance following induction therapy with a standard induction regimen has recently been approved for use in Japan. The efficacy and safety of combination therapy with ew-ADA maintenance following standard induction regimen plus intensive granulocyte and monocyte adsorptive apheresis (GMA) (two sessions/week) for the treatment of refractory ulcerative colitis (UC) displaying failure of conventional, biologics and Janus kinase inhibitor have not been evaluated previously. The present retrospective study evaluated the 10-week efficacy of this combination therapy among refractory UC patients. Six patients were given initial ADA combination therapy (ADA at 160 mg in week 0, ADA 80 mg in week 2, and 40 mg in week 4, followed by ew-ADA at 40 mg/week) plus intensive GMA. One patient (16.6%) achieved clinical remission and two patients (33.3%) achieved endoscopic improvement by week 10. After excluding two patients who discontinued treatment, mean full Mayo score (P = 0.14), endoscopic subscore (P = 0.18) and C-reactive protein level (P = 0.27) at 10 weeks were numerically decreased compared with baseline in the remaining four cases, although the differences were not significant. Use of ew-ADA maintenance following standard induction regimen plus intensive GMA appears unlikely to achieve satisfactory induction of clinical remission in UC patients for whom conventional agents, biologics and Janus kinase inhibitors have failed.
采用标准诱导方案诱导治疗后每周一次（ew）使用阿达木单抗（ADA）维持治疗最近已在日本获批。对于传统治疗、生物制剂和Janus激酶抑制剂治疗均失败的难治性溃疡性结肠炎（UC）患者，采用标准诱导方案加强化粒细胞和单核细胞吸附性血浆置换（GMA，每周两次）并联合ew-ADA维持治疗的疗效和安全性此前尚未得到评估。本回顾性研究评估了这种联合治疗方案在难治性UC患者中的10周疗效。6例患者接受了初始ADA联合治疗（第0周给予ADA 160 mg，第2周给予ADA 80 mg，第4周给予40 mg，随后每周给予ew-ADA 40 mg）加强化GMA治疗。到第10周时，1例患者（16.6%）实现临床缓解，2例患者（33.3%）实现内镜改善。在排除2例停止治疗的患者后，其余4例患者在10周时平均梅奥总评分（P = 0.14）、内镜子评分（P = =0.18）和C反应蛋白水平（P = 0.27）与基线相比虽有数值下降，但差异无统计学意义。对于传统药物、生物制剂和Janus激酶抑制剂治疗均失败的UC患者，采用标准诱导方案加强化GMA并联合ew-ADA维持治疗似乎不太可能实现令人满意的临床缓解诱导。
